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RES214
Improving Outcomes for Severe Traumatic Brain Injury Patients
By: K. Johnson & K. O'Phelan; The Queen's Medical Center, Honolulu, HI
For further information, please contact: KJohnson@queens.org
Purpose: The aim of this performance improvement project was to evaluate if discharge outcomes have improved for severe traumatic brain injury patients (GCS<9) after guidelines were implemented in January 2006.
Background/Significance: The Adam Williams Traumatic Brain Injury (AWTBI) Initiative assists trauma centers to adopt American Association of Neurological Surgeons (AANS)/Brain Trauma Foundation (BTF) traumatic brain injury (TBI) guidelines. Our trauma center was selected for this initiative in July 2005. Educational initiatives began in September 2005, and a multidisciplinary teamed formed to establish guidelines for the management of severe TBI patients at our facility.
Methods: A retrospective chart review of 148 severe TBI patients (GCS<9) admitted from January 2000-February 2006 (group 1) was compared to 40 prospective post-guideline (group 2) severe TBI patient charts from March 2006- June 2007. Data was entered into the BTF’s TBI-trac database. Outcomes included admission Glasgow coma score (aGCS), discharge Glasgow Coma Score (dGCS), ICU length of stay (LOS), and mortality.
Results: The mean age for group 1 was 40 years (range 16-85) and for group 2 was 36 years (range 14-69). In group 1, 78% of the patients were male, and in group 2 95% were male. Data for the 2 groups show, admission GCS was 4.4 vs. 4.8; ICU LOS 18 vs.17; dGCS of 3-8: 9 vs. 4%, 9-13: 21 vs.14% and 14-15: 70 vs.82%. The mean change in GCS from admission to discharge was 7.35 for group 1 and 8.36 for group 2. Mortality was 33% for group 1 vs. 32% for group 2. Statistical significance (p<0.001, adjusted for gender and age) was found in mean dGCS between the 2 groups (12.8 ± 3.06 vs. 13.45 ± 2.02) and the change in GCS from admission to discharge in group 2 (7.35 ± 4.8 vs. 8.36 ± 2.01).
Conclusions: Group 2 had a higher dGCS, which is likely a result of increased proportion of patients with dGCS>13. This can not determined statistically due to the small sample size. Improvements were noted in ICU LOS, transfers to other acute facilities, and mortality.
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