Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
Oakland University William Beaumont School of Medicine, Rochester, MI, USA; Department of Emergency Medicine, Beaumont Hospital System, Troy, MI, USA.
Am J Emerg Med. 2021 Jul;45:149-153. doi: 10.1016/j.ajem.2020.11.027. Epub 2020 Nov 18.
Intracranial injury in elderly patients presenting with minor head trauma is often overlooked in the emergency department (ED). Our suburban community-based level II trauma hospital developed and implemented the level III trauma protocol (L3TP) in January 2016 to better evaluate and diagnose intracranial injury in elderly patients presenting with minor head trauma after a fall. The L3TP requires that the ED physician immediately assess all patients meeting the following criteria 1) Age ≥ 65 years old. 2) Currently taking any anticoagulant or antiplatelet agents. 3) Presenting in the ED with a potential head injury after a fall. The ED physician determines if these high-risk patients require emergent imaging, obviating the need for trauma team activation unless an intracranial hemorrhage (ICH) is found. The purpose of this study was to assess the impact of the novel L3TP on resource utilization and patient outcome.
Our retrospective cohort study included patients who met the L3TP inclusion criteria and had an ICH diagnosed by non-contrast computed tomography (CT). We compared patients triaged by the L3TP (January to December 2017) to patients triaged before the L3TP was implemented (January to August 2015) in order to assess the impact of the L3TP on resource utilization and patient outcome. The data was analyzed using two independent samples t-tests and Chi-square tests.
Patients triaged by the L3TP had a significantly shorter average length of time from arrival in the ED to CT (level III trauma 0.64 h vs control 2.37 h, (d = 1.73; 95% CI = 1.42, 2.04), p ≤ 0.0001) and ED length of stay (level III trauma 2.55 h vs control 4.72 h, (d = 2.17; 95% CI = 1.21, 3.13), p ≤ 0.0001). There was insufficient evidence to conclude that there was any difference in health outcomes between the control and level III trauma groups.
The L3TP is an effective and resource efficient protocol that quickly identifies ICH in elderly patients without activating the trauma team for every elderly patient presenting to the ED with a potential head injury after a fall.
在急诊科（ED），老年人因轻微头部外伤导致的颅内损伤常常被忽视。我们的郊区二级创伤医院于 2016 年 1 月制定并实施了三级创伤方案（L3TP），以更好地评估和诊断因跌倒后出现轻微头部外伤的老年患者的颅内损伤。L3TP 要求 ED 医生立即评估所有符合以下标准的患者：1）年龄≥65 岁。2）目前正在服用任何抗凝或抗血小板药物。3）在 ED 因跌倒后出现潜在的头部损伤。ED 医生会确定这些高危患者是否需要紧急影像学检查，除非发现颅内出血（ICH），否则无需激活创伤小组。本研究的目的是评估新型 L3TP 对资源利用和患者结局的影响。
我们的回顾性队列研究包括符合 L3TP 纳入标准且通过非对比 CT 诊断为 ICH 的患者。我们将 L3TP 分诊的患者（2017 年 1 月至 12 月）与 L3TP 实施前（2015 年 1 月至 8 月）分诊的患者进行比较，以评估 L3TP 对资源利用和患者结局的影响。使用两独立样本 t 检验和卡方检验对数据进行分析。
L3TP 分诊的患者从到达 ED 到 CT 的平均时间明显缩短（三级创伤组 0.64h 与对照组 2.37h，d=1.73；95%CI=1.42,2.04），ED 停留时间也明显缩短（三级创伤组 2.55h 与对照组 4.72h，d=2.17；95%CI=1.21,3.13），p 值均≤0.0001。没有足够的证据表明控制组和三级创伤组在健康结局方面存在差异。
L3TP 是一种有效且资源高效的方案，它可以快速识别跌倒后出现轻微头部外伤的老年患者的 ICH，而无需对每位出现潜在头部损伤的老年患者都激活创伤小组。
