Macleod Skye, Melville Geoffrey, Samimi-Duncan Aden, Khan Shanawaz, Binks Simon, Hernandez Daniel, Cherukuri Ravi, Keane Simon, Curtis Kate
Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales, Australia.
Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
Emerg Med Australas. 2025 Apr;37(2):e70026. doi: 10.1111/1742-6723.70026.
Many time-critical neurosurgical brain conditions do not meet traditional ED major trauma or stroke team activation criteria and thus do not benefit from the associated expedited imaging and specialist review. To address this, a "Critical Head" protocol was developed. The aim was to determine the effect of this on time to CT scan, neurosurgical intervention (if indicated) and specialist team review.
Quasi-experimental study, involving retrospective analyses of data of all potential Critical Head patients presenting to Wollongong ED from 1 January 2018 to 26 May 2023, with the protocol go-live on 7 March 2023. Descriptive statistics and study outcomes were compared before and after protocol implementation. R Studio 2024 was used for analyses and alpha was set to 0.05.
Two hundred and two patients were included (123 control/pre-intervention, 119 intervention). There was no significant difference in age, sex or presence of intracranial conditions between groups. Median time from triage to CT decreased in the intervention group by 15% (7 min, 47[33,95] to 40[25,66], P = 0.020). There was a 33% (67 min) reduction to surgery start time in the intervention (204[621752] to 137[108247] min, P = 0.042) (urgent neurosurgery). Reductions in time to specialist team reviews were observed in ICU (n = 86, 132[58192] to 42[6103] min, P < 0.001) and neurosurgery (n = 158, 104[69 202] to 44[16111] min, P < 0.001). ICU and hospital length of stay did not differ significantly, nor did Glasgow Coma Outcome Scale score at discharge.
The Critical Head protocol for patients with time-critical intracranial conditions reduced time to CT scan, operative intervention and specialist team review.
许多对时间要求紧迫的神经外科脑部疾病不符合传统急诊科重大创伤或卒中团队启动标准，因此无法从相关的快速成像和专家评估中获益。为解决这一问题，制定了一项“危急头部”方案。目的是确定该方案对进行CT扫描的时间、神经外科干预（如需要）以及专家团队评估的影响。
准实验研究，对2018年1月1日至2023年5月26日在卧龙岗急诊科就诊的所有潜在危急头部患者的数据进行回顾性分析，该方案于2023年3月7日开始实施。比较方案实施前后的描述性统计数据和研究结果。使用R Studio 2024进行分析，α设定为0.05。
纳入202例患者（123例对照组/干预前，119例干预组）。两组在年龄、性别或颅内疾病存在情况方面无显著差异。干预组从分诊到CT的中位时间减少了15%（7分钟，47[33,95]降至40[25,66]，P = 0.020）。干预组手术开始时间减少了33%（67分钟）（204[62,1752]降至137[108,247]分钟，P = 0.042）（紧急神经外科手术）。在重症监护室（n = 86，132[58,192]降至42[6,103]分钟，P < 0.001）和神经外科（n = 158，104[69,202]降至44[16,111]分钟，P < 0.001）观察到专家团队评估时间减少。重症监护室和住院时间无显著差异，出院时格拉斯哥昏迷量表评分也无差异。
针对对时间要求紧迫的颅内疾病患者的危急头部方案减少了进行CT扫描、手术干预和专家团队评估的时间。
