Review Article: Emergency Medical Services Transfer of Severe Traumatic Brain Injured Patients to a Neuroscience Centre: A Systematic Review

Jones, B
Dicker, B
Howie, G
Todd, V
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Journal Article
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Patients with severe traumatic brain injuries require urgent medical attention at a hospital. We evaluated whether transporting adult patients with a severe traumatic brain injury (TBI) to a Neuroscience Centre is associated with reduced mortality. We reviewed studies published between 2010 and 2023 on severe TBI in adults (>18 years) using Medline, CINAHL, Google Scholar and Cochrane databases. We focused on mortality rates and the impact of transferring patients to a Neuroscience Centre, delays to neurosurgery and EMS triage accuracy. This review analysed seven studies consisting of 53 365 patients. When patients were directly transported to a Neuroscience Centre, no improvement in survivability was demonstrated. Subsequently, transferring patients from a local hospital to a Neuroscience Centre was significantly associated with reduced mortality in one study (adjusted odds ratio: 0.79, 95% confidence interval: 0.64–0.96), and 24-h (relative risk [RR]: 0.31, 0.11–0.83) and 30-day (RR: 0.66, 0.46–0.96) mortality in another. Patients directly transported to a Neuroscience Centre were more unwell than those taken to a local hospital. Subsequent transfers increased time to CT scanning and neurosurgery in several studies, although these were not statistically significant. Additionally, EMS could accurately triage. None of the included studies demonstrated statistically significant findings indicating that direct transportation to a Neuroscience Centre increased survivability for patients with severe traumatic brain injuries. Subsequent transfers from a non-Neuroscience Centre to a Neuroscience Centre reduced mortality rates at 24 h and 30 days. Further research is required to understand the differences between direct transport and subsequent transfers to Neuroscience Centres.

EMS , Mortality , Neuroscience Centre , TBI , Transfer , 32 Biomedical and Clinical Sciences , 3202 Clinical Sciences , Physical Injury - Accidents and Adverse Effects , Traumatic Head and Spine Injury , Brain Disorders , Neurosciences , Traumatic Brain Injury (TBI) , Clinical Research , Neurological , Injuries and accidents , 3 Good Health and Well Being , 1103 Clinical Sciences , 1117 Public Health and Health Services , Emergency & Critical Care Medicine , 3202 Clinical sciences
EMA - Emergency Medicine Australasia, ISSN: 1742-6731 (Print); 1742-6723 (Online), Wiley. doi: 10.1111/1742-6723.14375
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© 2024 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.