The Impact of a Concurrent Trauma Alert Evaluation on Time to Head Computed Tomography in Patients with Suspected Stroke

Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Academic Emergency Medicine (Impact Factor: 2.01). 04/2006; 13(3):349-52. DOI: 10.1197/j.aem.2005.10.011
Source: PubMed


Emergency department (ED) overcrowding threatens quality of care by delaying the time to diagnosis and treatment of patients with time-sensitive diseases, such as acute stroke.
The authors hypothesized that the presence of a trauma alert evaluation would impede the time to head computed tomography (hCT) in patients with stroke-like symptoms.
This was a secondary analysis of prospectively collected data on patients with potential stroke who received an hCT in an urban trauma center ED from January 1, 2004, to November 30, 2004. Structured data collection included historical and examination items, National Institutes of Health (NIH) stroke scale score, laboratory and radiographic results, and final diagnosis. Admitted patients were followed in hospital. Patients who presented within one hour following a trauma evaluation were compared with patients who presented without concurrent trauma for triage time until completion of hCT. Chi-square, t-tests, and 95% confidence intervals (95% CIs) were used for comparisons.
The 171 patients enrolled had a mean (+/- standard deviation) age of 60.7 (+/- 7) years; 60% were female; and 58% were African American. Of these, 72 patients had a significant cerebrovascular event (38 [22%] ischemic stroke, 25 [15%] transient ischemic attack, seven [4%] intracranial hemorrhage, one [0.6%] subarachnoid hemorrhage, and one [0.6%] subdural hematoma). The remaining diagnoses included 4.6% migraine, 2.3% seizure, 2.9% syncope, 2.3% Bell's palsy, and 2.9% vertigo. There was no significant difference in time to hCT in patients who presented during a trauma activation and those who did not (99 minutes [interquartile range (IQR) = 24-156] vs. 101 minutes [IQR = 43-151.5]; p = 0.537). In subgroup analysis of patients with a significant cerebrovascular event, times to hCT were also similar (24 minutes [IQR = 12-99] vs. 61 minutes [IQR = 15-126]; p = 0.26).
In the authors' institution, the presence of concurrent trauma evaluation does not delay CT imaging of patients with potential stroke.

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Available from: Angela M Mills, Mar 17, 2015
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    • "In one of the few reviews of CT efficiency, Fung Kon Jin and colleagues [10] found that the median start time in a high-volume “stream-lined” level-1 American trauma center for a severely injured cohort (median ISS 18) was 82 minutes, with the median time from arrival until completion of the diagnostic trauma evaluation being nearly 2 hours (114 minutes). The relevance of this time may be increased by noting that the mean time to CT head for non-traumatic neurological emergencies in a tertiary care academic institution that prioritized CT scanning for potential stroke over all other emergency department patients except trauma was either 99 or 101 minutes, depending on whether there were competing trauma activations [26]. "
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