Surgical Registrar, Christchurch Hospital, Canterbury District Health Board, New Zealand.
Trauma Nurse Coordinator, Christchurch Hospital, Canterbury District Health Board, New Zealand.
N Z Med J. 2021 Mar 26;134(1531):59-66.
Mild traumatic brain injury (mild TBI) is a common, poorly managed condition with an underestimated impact and inadequate follow-up. This study aimed to assess local practice in terms of assessment and follow-up.
A retrospective review of all patients presenting to Christchurch Hospital between 1 August 2019 and 30 September 2019 with ICD-10 coded diagnosis of head trauma was conducted. Patients younger than 16 or older than 80 years who had a concurrent medical illness or who did not meet diagnostic criteria for mild TBI were excluded. This was to minimise diagnostic uncertainty where patients may have had mild TBI like symptoms due to alternate pathology. Primary outcomes included documentation of post-traumatic amnesia (PTA) with the Abbreviated Westmead Post-Traumatic Amnesia Scale (A-WPTAS), provision of mild TBI information, the proportion referred for follow-up and the proportion followed up at the mild TBI clinic. Demographic data included age, sex, ethnicity, mechanism of injury, admission service and rate of admission.
A total of 525 patients were identified, with 239 patients included. Median age was 29 years (IQR 22-50) and 65.3% (n=156) were male. The most common mechanisms of injury were falls (25.5%, n=61) and assault (25.5%, n=61). The most-commonly recorded diagnosis was head injury (41.4%, n=99), followed by concussion (34.3%, n=82). A-WPTAS was documented for 4.2% of patients (n=10). The provision of written mild TBI advice to patients was documented in 61.5% of cases (n=147). On discharge, no follow-up was documented for 63.6% of patients (n=152). In those with documented follow-up, 23.4% (n=56) was with a general practitioner (GP) and 5.4% (n=13) were referred to mild TBI clinic. Review of Accident Corporation Commission (ACC) records identified claims for 80.3% (n=192) of the cohort. Of these, 11.5% (n=22) received a payment for mild TBI services and 2.1% (n=4) had their service provided by Christchurch Hospital.
The results suggest that current management of mild TBI at Christchurch Hospital needs improvement. Accurate diagnostic coding allows patients to access ACC-funded clinics. The utilisation rates of these clinics confirm that the frequency of specialist follow-up is low, which is in keeping with the international literature. Furthermore, given the strongly predictive nature of post-traumatic amnesia for outcomes, the low rate of A-WPTAS assessment is concerning. These results suggest that a mild TBI protocol is needed to standardise assessment, management and follow-up.
轻度创伤性脑损伤（mild TBI）是一种常见且管理不善的疾病，其影响被低估，后续治疗也不足。本研究旨在评估评估和随访方面的当地实践。
对 2019 年 8 月 1 日至 2019 年 9 月 30 日期间因 ICD-10 编码诊断为头部创伤而在克赖斯特彻奇医院就诊的所有患者进行回顾性分析。排除年龄小于 16 岁或大于 80 岁、有合并内科疾病或不符合轻度 TBI 诊断标准的患者。这是为了尽量减少因其他病理学原因而可能导致轻度 TBI 样症状的患者的诊断不确定性。主要结局包括使用简化的怀塔基创伤后遗忘量表（A-WPTAS）记录创伤后遗忘（PTA），提供轻度 TBI 信息，以及为随访提供的比例和在轻度 TBI 诊所进行随访的比例。人口统计学数据包括年龄、性别、种族、损伤机制、入院服务和入院率。
共确定了 525 名患者，其中纳入了 239 名患者。中位年龄为 29 岁（IQR 22-50），65.3%（n=156）为男性。最常见的损伤机制是跌倒（25.5%，n=61）和袭击（25.5%，n=61）。最常见的诊断是头部损伤（41.4%，n=99），其次是脑震荡（34.3%，n=82）。仅 4.2%（n=10）的患者记录了 A-WPTAS。记录了 61.5%（n=147）的患者提供书面轻度 TBI 建议。出院时，63.6%（n=152）的患者未记录随访情况。在有记录的随访中，23.4%（n=56）在全科医生（GP）就诊，5.4%（n=13）被转介至轻度 TBI 诊所。对意外事故委员会（ACC）记录的审查确定，该队列中有 80.3%（n=192）的患者提出了索赔。其中，11.5%（n=22）获得了轻度 TBI 服务的赔偿，2.1%（n=4）接受了克赖斯特彻奇医院的服务。
研究结果表明，克赖斯特彻奇医院目前对轻度 TBI 的管理需要改进。准确的诊断编码使患者能够获得 ACC 资助的诊所服务。这些诊所的利用率证实，专科随访的频率较低，这与国际文献一致。此外，鉴于创伤后遗忘对预后的预测作用很强，A-WPTAS 评估率较低令人担忧。这些结果表明，需要制定轻度 TBI 方案以规范评估、管理和随访。
