Revisits for Traumatic Brain Injury in Emergency Department, Samut Sakhon Hospital

Abstract

Introduction Traumatic brain injury (TBI) is a significant clinical problem in Thailand. Emergency Department (ED), Samut sakhon hospital has followed the Clinical Practice Guidelines for TBI (June 2019) conducted by Royal College of Neurological Surgeons of Thailand. For the benefit of further improvement of patient care. This study, therefore, was conducted on TBI patients who received treatment according to the above-mentioned guideline.

Objectives Our main outcome included revisits for Traumatic Brain Injury (TBI) within 14 days of index visit. We also studied the prevalence of TBI (classified by severity).

Method This was a retrospective descriptive medical record review of all TBIs who were at least 15 years old presenting to emergency department (ED), Samutsakhon hospital between January and December 2020. Patients who transferred from other hospital were excluded from this study.

Results A total of 1294 patients with TBI were enrolled. According to severity of injury, 1,169 (90.34%) patients had mild TBI, 51 (3.94%) had moderate, 74 (5.72%) had severe, respectively. The common mechanisms of injury were motorcycle accidents 39.2% and falls 27.7%. There were 57 cases (4.5%) who were patients with unplanned hospital revisits within 14 days of index visit. Of those cases, 1 was moderate TBI patient and the rest were mild TBI patients. The mortality rate was found to be 35 cases (2.7%) among TBI patients, 10 cases (0.9%), 6 cases (11.8%) and 19 cases (25.7%) were mild, moderate and severe TBI patients, respectively. All mild TBI deaths were moderate and high-risk patients.

Conclusion This study had the lower TBI revisit and mortality rates when compared to the result of studies over the past decade. This resulted from the revision of treatment guideline for the TBI patients. Finding from this study confirmed that mild TBI (low risk) patients can be discharged with mild TBI warning discharge instructions. Motorcycle accidents and falls were the predominant mechanisms of injury. Therefore, it is suggested that a role for the multifaceted traffic injury prevention programs, fall prevention strategies, improvement of emergency medical service systems and proper treatment protocols should be implemented.