sTBI Acute workstream

Around 35 percent of all patients with major trauma in Aotearoa New Zealand have an associated sTBI. Analysis of the New Zealand Trauma Registry suggested that how sTBI is managed and outcomes for patients who experience injury varies by population, geography and destination hospital.

This variation is not well understood, and it may affect a patient’s long-term recovery and present barriers for people who need to access the right care in the right place at the right time following serious injury.

An expert advisory group was formed to guide this project; it includes experienced allied health, medical and nursing professionals; rehabilitation provider services; and consumers and whānau with lived experience of TBI.

Key findings from initial scoping work indicate that approximately 50 percent of patients with TBI are initially admitted to non-neuroscience centres. Data from the national trauma registry suggests that both access to specialist neuroscience centres and outcomes after sTBI vary significantly by region. [1]

Traditionally, the decision to transfer a patient following sTBI is determined by whether there is an absolute or potential need for neurosurgical intervention. Neurosurgery is an essential part of sTBI management, but sTBI patients who do not require surgery also experience improved outcomes when admitted to a neuroscience centre. [2,3] This is likely because these centres deal with more TBI patients and have immediate access to neuro-subspecialty teams and specialist allied health and nursing staff.

Current international consensus suggests that patients with TBI (Glasgow Coma Scale [GCS] score of <9) should be admitted to a neuroscience centre regardless of their need for neurosurgery. When this policy was adopted in England, sTBI-related mortality declined significantly. [4,5] A quality improvement campaign has engaged stakeholders across the sector to develop a nationally agreed action plan and care pathway to facilitate the transfer of sTBI patients to neuroscience centres in Aotearoa New Zealand.

References

[1] New Zealand Trauma Registry and National Trauma Network. 2020. Annual report 2019/20. URL: www.majortrauma.nz/assets/Publication-Resources/Annual-reports/National-Trauma-Network-Annual-report-2019-20220.pdf

[2] Harrison DA, Prabhu G, Grieve R, et al. 2013. Risk Adjustment In Neurocritical care (RAIN) – prospective validation of risk prediction models for adult patients with acute traumatic brain injury to use to evaluate the optimum location and comparative costs of neurocritical care: A cohort study. Health Technology Assessment 17(23): VII–VIII, 1–350.

[3] Fuller G, Pallot D, Coats T, et al. 2014. The effectiveness of specialist neuroscience care in severe traumatic brain injury: a systematic review. British Journal of Neurosurgery 28(4): 452–60. 

[4] National Institute for Health and Care Excellence. 2014. Head injury: triage, assessment, investigation and early management of head injury in infants, children and adults. Clinical guideline 176. London: NICE.

[5] Marincowitz C, Lecky F, Allgar V, et al. 2019. Evaluation of the impact of the NICE head injury guidelines on inpatient mortality from traumatic brain injury: an interrupted time series analysis. BMJ Open 9(6): e028912.