Rajwani Kapil Mohan, Lavrador Jose Pedro, Ansaripour Ali, Tolias Christos M
Department of Neurosurgery, King's College Hospital, London, UK.
King's College London, London, UK.
Br J Neurosurg. 2020 Jun;34(3):271-275. doi: 10.1080/02688697.2020.1742289. Epub 2020 Mar 26.
Within the pan London Major Trauma System many patients with minor or non-life threatening traumatic brain injury (TBI) remain at their local hospital and are not transferred to a major trauma centre (MTC). Our aim was to identify factors that influence the decision to transfer patients with TBI to a neurosurgical centre. This is a single centre prospective cohort study of all patients with TBI referred to our neurosurgery unit from regional acute hospitals over a 4-month period (Sept 2016-Jan 2017). Our primary outcome was transferred to a neurosurgical centre. We identified the following factors that may predict decision to transfer: patient demographics, transfer distance, antithrombotic therapy and severity of TBI based on initial Glasgow Coma Scale (GCS) and Marshall CT score. A multivariable logistic regression analysis was performed. A total of 339 patients were referred from regional hospitals with TBI and of these, 53 (15.6%) were transferred to our hospital. The mean age of patients referred was 70.6 years, 62.5% were men and 43% on antithrombotic drugs. Eighty-six percent of patients had mild TBI (GCS 13-15) on initial assessment and 79% had a Marshall CT score of 2. The adjusted analysis revealed only higher age, higher Marshall Score, the presence of chronic subdural haematoma (CSDH), the presence of contusion(s) and fracture(s) predicted transfer (<.05). Subgroup analysis consistently showed a higher Marshall score predicted transfer (<.05). In our cohort higher Marshall score consistently predicted transfer to our neurosurgical centre. Presenting GCS, transfer distance and antithrombotic therapy did not influence decision to transfer.
在泛伦敦重大创伤系统中，许多患有轻度或非危及生命的创伤性脑损伤（TBI）的患者留在当地医院，未被转至重大创伤中心（MTC）。我们的目的是确定影响将TBI患者转至神经外科中心这一决策的因素。这是一项单中心前瞻性队列研究，研究对象为在4个月期间（2016年9月至2017年1月）从地区急症医院转诊至我们神经外科的所有TBI患者。我们的主要结局是转至神经外科中心。我们确定了以下可能预测转院决策的因素：患者人口统计学特征、转院距离、抗血栓治疗以及基于初始格拉斯哥昏迷量表（GCS）和马歇尔CT评分的TBI严重程度。进行了多变量逻辑回归分析。共有339例TBI患者从地区医院转诊而来，其中53例（15.6%）转至我院。转诊患者的平均年龄为70.6岁，62.5%为男性，43%正在接受抗血栓药物治疗。86%的患者初始评估为轻度TBI（GCS 13 - 15），79%的患者马歇尔CT评分为2分。校正分析显示，只有年龄较大、马歇尔评分较高、存在慢性硬膜下血肿（CSDH）、存在挫伤和骨折可预测转院（P <.05）。亚组分析一致显示较高的马歇尔评分可预测转院（P <.05）。在我们的队列中，较高的马歇尔评分一直可预测转至我们的神经外科中心。初始GCS、转院距离和抗血栓治疗并未影响转院决策。
