Utility and effectiveness of the Scandinavian guidelines to exclude computerized tomography scanning in mild traumatic brain injury - a prospective cohort study
Abstract Background In 2013 the Scandinavian Neurotrauma Committee (SNC) published updated guidelines for the initial management of minimal, mild and moderate traumatic head injuries (MTHI) that included serum analysis of protein S100B as a marker for brain tissue damage. This study reviews the effe...
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| Format: | Article |
| Language: | English |
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BMC
2018-11-01
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| Series: | BMC Emergency Medicine |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12873-018-0193-2 |
| _version_ | 1819150475882135552 |
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| author | Arurann Ananthaharan Gunnhild Kravdal Truls Martin Straume-Naesheim |
| author_facet | Arurann Ananthaharan Gunnhild Kravdal Truls Martin Straume-Naesheim |
| author_sort | Arurann Ananthaharan |
| collection | DOAJ |
| description | Abstract Background In 2013 the Scandinavian Neurotrauma Committee (SNC) published updated guidelines for the initial management of minimal, mild and moderate traumatic head injuries (MTHI) that included serum analysis of protein S100B as a marker for brain tissue damage. This study reviews the effectiveness of the new guidelines in a clinical setting. Methods For all patients admitted to Akershus University Hospital (AHUS) from June 30th 2014 to December 15th 2014 with MTHI a separate form was filled in recording the time, indication and result of any S100B sampling and/or head computer tomography (CT) examinations. Data from these forms were compared to information derived from the electronic patient records for patients with MTHI and related diagnoses and data from the laboratory for all patients that had undergone the S100B analysis within the same period. Results Five hundred seventy-five patients were identified with MTHI, S100B sampling was indicated for 223 (38.8%) patients and carried out for 188 (84.3%) of these patients. 69 (36.7%) of the patients had a negative S100B test, but a head CT scan was still performed in 31 cases despite the negative S100B test. In total the guidelines were followed for 362 of 575 patients (63.0%). 180 (31.3%) of the MTHI cases were discharged without further observation or CT examinations, including 38 (21.1%) as a direct result of S100B testing. No re-admissions or missed initial traumatic brain injuries were observed. Conclusion The implementation of the updated SNC guidelines resulted in direct discharge of more than one third of the MTHI cases without further observation or CT examinations. One in five of these discharges was a direct result of S100B testing. However, compliance to the guidelines were poor and the guidelines were only followed in 40%. While this study showed benefits of implementing SNC guidelines to reduce the number of CT scans, additional training is needed for optimal use. |
| first_indexed | 2024-12-22T14:18:06Z |
| format | Article |
| id | doaj.art-21721754d39a443aaba6810e10200707 |
| institution | Directory Open Access Journal |
| issn | 1471-227X |
| language | English |
| last_indexed | 2024-12-22T14:18:06Z |
| publishDate | 2018-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Emergency Medicine |
| spelling | doaj.art-21721754d39a443aaba6810e102007072022-12-21T18:23:03ZengBMCBMC Emergency Medicine1471-227X2018-11-011811810.1186/s12873-018-0193-2Utility and effectiveness of the Scandinavian guidelines to exclude computerized tomography scanning in mild traumatic brain injury - a prospective cohort studyArurann Ananthaharan0Gunnhild Kravdal1Truls Martin Straume-Naesheim2Akershus University HospitalMultidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University HospitalClinic of Orthopedic Surgery, Akershus University HospitalAbstract Background In 2013 the Scandinavian Neurotrauma Committee (SNC) published updated guidelines for the initial management of minimal, mild and moderate traumatic head injuries (MTHI) that included serum analysis of protein S100B as a marker for brain tissue damage. This study reviews the effectiveness of the new guidelines in a clinical setting. Methods For all patients admitted to Akershus University Hospital (AHUS) from June 30th 2014 to December 15th 2014 with MTHI a separate form was filled in recording the time, indication and result of any S100B sampling and/or head computer tomography (CT) examinations. Data from these forms were compared to information derived from the electronic patient records for patients with MTHI and related diagnoses and data from the laboratory for all patients that had undergone the S100B analysis within the same period. Results Five hundred seventy-five patients were identified with MTHI, S100B sampling was indicated for 223 (38.8%) patients and carried out for 188 (84.3%) of these patients. 69 (36.7%) of the patients had a negative S100B test, but a head CT scan was still performed in 31 cases despite the negative S100B test. In total the guidelines were followed for 362 of 575 patients (63.0%). 180 (31.3%) of the MTHI cases were discharged without further observation or CT examinations, including 38 (21.1%) as a direct result of S100B testing. No re-admissions or missed initial traumatic brain injuries were observed. Conclusion The implementation of the updated SNC guidelines resulted in direct discharge of more than one third of the MTHI cases without further observation or CT examinations. One in five of these discharges was a direct result of S100B testing. However, compliance to the guidelines were poor and the guidelines were only followed in 40%. While this study showed benefits of implementing SNC guidelines to reduce the number of CT scans, additional training is needed for optimal use.http://link.springer.com/article/10.1186/s12873-018-0193-2Mild brain injuryClinical assessment of CNS injurys100bHead injuryCT scanningHead trauma |
| spellingShingle | Arurann Ananthaharan Gunnhild Kravdal Truls Martin Straume-Naesheim Utility and effectiveness of the Scandinavian guidelines to exclude computerized tomography scanning in mild traumatic brain injury - a prospective cohort study BMC Emergency Medicine Mild brain injury Clinical assessment of CNS injury s100b Head injury CT scanning Head trauma |
| title | Utility and effectiveness of the Scandinavian guidelines to exclude computerized tomography scanning in mild traumatic brain injury - a prospective cohort study |
| title_full | Utility and effectiveness of the Scandinavian guidelines to exclude computerized tomography scanning in mild traumatic brain injury - a prospective cohort study |
| title_fullStr | Utility and effectiveness of the Scandinavian guidelines to exclude computerized tomography scanning in mild traumatic brain injury - a prospective cohort study |
| title_full_unstemmed | Utility and effectiveness of the Scandinavian guidelines to exclude computerized tomography scanning in mild traumatic brain injury - a prospective cohort study |
| title_short | Utility and effectiveness of the Scandinavian guidelines to exclude computerized tomography scanning in mild traumatic brain injury - a prospective cohort study |
| title_sort | utility and effectiveness of the scandinavian guidelines to exclude computerized tomography scanning in mild traumatic brain injury a prospective cohort study |
| topic | Mild brain injury Clinical assessment of CNS injury s100b Head injury CT scanning Head trauma |
| url | http://link.springer.com/article/10.1186/s12873-018-0193-2 |
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