Takahiro Kinoshita1, Motohisa Hayashi1, Kazuma Yamakawa2, Atsushi Watanabe1, Jumpei Yoshimura1, Toshimitsu Hamasaki3, Satoshi Fujimi1. 1. Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Sumiyoshi-ku, Osaka, Japan. 2. Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Sumiyoshi-ku, Osaka, Japan. Electronic address: k.yamakawa0911@gmail.com. 3. Department of Data Science, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Abstract
OBJECTIVE: The timely treatment of severe traumatic brain injury (TBI) is essential for limiting the effects of damage; however, there is no consensus regarding an effective method for early intervention. In August 2011, our hospital launched a novel trauma workflow using the hybrid emergency room (ER), consisting of an interventional radiology-computed tomography (CT) unit installed in the trauma resuscitation room to facilitate early interventions. The aim of this study was to evaluate effects of the hybrid ER system on functional outcomes in patients with severe TBI. METHODS: We conducted a retrospective historical control study of patients with severe TBI (Glasgow Coma Scale score ≤8) who received conventional treatment (August 2007-July 2011) or treatment in the hybrid ER (August 2011-July 2015). The primary end point was unfavorable outcome at 6 months after injury (death, vegetative state, or lower severe disability) as evaluated by the Glasgow Outcome Scale-Extended. Secondary end points included time from arrival to the start of CT examination and emergency intracranial operation. Potential confounders were adjusted with multivariable logistic regressions. RESULTS: Among 158 included patients, 88 were in the conventional group and 70 were in the hybrid ER group. After model adjustment, the hybrid ER group was significantly associated with a reduction in unfavorable outcomes. Times to CT examination and intracranial operation were significantly shorter in the hybrid ER group than that in the conventional group. CONCLUSIONS: The hybrid ER system is useful for realizing immediate CT examination and emergency surgery and improving functional outcomes in patients with severe TBI.
OBJECTIVE: The timely treatment of severe traumatic brain injury (TBI) is essential for limiting the effects of damage; however, there is no consensus regarding an effective method for early intervention. In August 2011, our hospital launched a novel trauma workflow using the hybrid emergency room (ER), consisting of an interventional radiology-computed tomography (CT) unit installed in the trauma resuscitation room to facilitate early interventions. The aim of this study was to evaluate effects of the hybrid ER system on functional outcomes in patients with severe TBI. METHODS: We conducted a retrospective historical control study of patients with severe TBI (Glasgow Coma Scale score ≤8) who received conventional treatment (August 2007-July 2011) or treatment in the hybrid ER (August 2011-July 2015). The primary end point was unfavorable outcome at 6 months after injury (death, vegetative state, or lower severe disability) as evaluated by the Glasgow Outcome Scale-Extended. Secondary end points included time from arrival to the start of CT examination and emergency intracranial operation. Potential confounders were adjusted with multivariable logistic regressions. RESULTS: Among 158 included patients, 88 were in the conventional group and 70 were in the hybrid ER group. After model adjustment, the hybrid ER group was significantly associated with a reduction in unfavorable outcomes. Times to CT examination and intracranial operation were significantly shorter in the hybrid ER group than that in the conventional group. CONCLUSIONS: The hybrid ER system is useful for realizing immediate CT examination and emergency surgery and improving functional outcomes in patients with severe TBI.
Authors: Edoardo Picetti; Ronald V Maier; Sandra Rossi; Andrew W Kirkpatrick; Walter L Biffl; Philip F Stahel; Ernest E Moore; Yoram Kluger; Gian Luca Baiocchi; Luca Ansaloni; Vanni Agnoletti; Fausto Catena Journal: World J Emerg Surg Date: 2019-03-04 Impact factor: 5.469
Authors: Edoardo Picetti; Sandra Rossi; Fikri M Abu-Zidan; Luca Ansaloni; Rocco Armonda; Gian Luca Baiocchi; Miklosh Bala; Zsolt J Balogh; Maurizio Berardino; Walter L Biffl; Pierre Bouzat; Andras Buki; Marco Ceresoli; Randall M Chesnut; Osvaldo Chiara; Giuseppe Citerio; Federico Coccolini; Raul Coimbra; Salomone Di Saverio; Gustavo P Fraga; Deepak Gupta; Raimund Helbok; Peter J Hutchinson; Andrew W Kirkpatrick; Takahiro Kinoshita; Yoram Kluger; Ari Leppaniemi; Andrew I R Maas; Ronald V Maier; Francesco Minardi; Ernest E Moore; John A Myburgh; David O Okonkwo; Yasuhiro Otomo; Sandro Rizoli; Andres M Rubiano; Juan Sahuquillo; Massimo Sartelli; Thomas M Scalea; Franco Servadei; Philip F Stahel; Nino Stocchetti; Fabio S Taccone; Tommaso Tonetti; George Velmahos; Dieter Weber; Fausto Catena Journal: World J Emerg Surg Date: 2019-11-29 Impact factor: 5.469