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{
    "pk": 11846,
    "title": "Rapid Discharge After Interfacility Transfer for Mild Traumatic Intracranial Hemorrhage: Frequency and Associated Factors",
    "subtitle": null,
    "abstract": "Introduction:\n Traumatic intracranial hemorrhage (TIH), brain injury with radiographic hemorrhage, is a common emergency department (ED) presentation, and encompasses a wide range of clinical syndromes. Patients with moderate and severe neurotrauma (Glasgow Coma Scale [GCS] < 13) with intracranial hemorrhage require care at a trauma center with neurosurgical capabilities. However, many patients with mild traumatic intracranial hemorrhage (mTIH), defined as radiographic bleeding and GCS ≥ 13, do not require operative intervention or intensive care unit monitoring, but are still routinely transferred to tertiary care centers. We hypothesized that a significant proportion of patients are managed non-operatively and are discharged within 24 hours of admission.\nMethods:\n This was a retrospective, observational study of consecutive patients age ≥ 16 years, GCS ≥ 13 who were transferred to an urban, medical school-affiliated, 100,000 annual visit ED over a seven-year period with blunt isolated mTIH. The primary outcome was discharge within 24 hours of admission. We measured rates of neurosurgical intervention, computed tomography hemorrhage progression, and neurologic deterioration as well as other demographic and clinical variables.\nResults:\n There were 1079 transferred patients with isolated mTIH. Of these, 92.4% were treated non-operatively and 35.8% were discharged within 24 hours of presentation to the tertiary ED. Patient characteristics associated with rapid discharge after transfer include a GCS of 15 (odds ratio [OR] 2.9, 95% confidence interval [CI], 1.9 – 4.4), subdural hematoma ≤ 6mm (OR 3.1, 95% CI, 2.2 – 4.5) or the presence of an isolated subarachnoid hemorrhage (OR 1.7, 95% CI, 1.3 – 2.4). Of patients with length of stay < 24 hours, 79.8% were discharged directly from the ED or ED observation unit. \nConclusion:\n Patients transferred to tertiary care centers are frequently discharged after brief observation without intervention. Risk can be predicted by clinical and radiographic data. Further prospective research is required to determine a safe cohort of patients who could be managed at community sites.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "mild head trauma, traumatic intracranial hemorrhage, inter-facility transfer, head injury"
        }
    ],
    "section": "Health Outcomes",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/0tq9v87d",
    "frozenauthors": [
        {
            "first_name": "Pierre",
            "middle_name": "",
            "last_name": "Borczuk",
            "name_suffix": "",
            "institution": "Harvard Medical School, Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Jonathan",
            "middle_name": "Van",
            "last_name": "Ornam",
            "name_suffix": "",
            "institution": "Harvard Medical School, Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Brian",
            "middle_name": "J.",
            "last_name": "Yun",
            "name_suffix": "",
            "institution": "Harvard Medical School, Massachusetts General Hospital, Department of Emergency Medicine, Boston, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Joshua",
            "middle_name": "",
            "last_name": "Penn",
            "name_suffix": "",
            "institution": "Winchester Hospital, Emergency Services, Winchester, Massachusetts",
            "department": "None"
        },
        {
            "first_name": "Peter",
            "middle_name": "",
            "last_name": "Pruitt",
            "name_suffix": "",
            "institution": "Northwestern University, Department of Emergency Medicine, Chicago, Illinois",
            "department": "None"
        }
    ],
    "date_submitted": "2018-06-11T17:10:26Z",
    "date_accepted": "2018-06-11T17:10:26Z",
    "date_published": "2019-02-11T20:40:44Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/westjem/article/11846/galley/6342/download/"
        }
    ]
}