Authors (including presenting author) :
Dr Li YH(1), Dr Cheung NK(1), Dr Cheng CH(1), Dr Man SY(1), Dr Chan YC(2) , Dr Ng YT(2), Ms Chung YM(1), Ms Chuk LK(1), Ms Lee KM(1), Ms Hau SS(1), Prof C Graham(3)
Affiliation :
1. Emergency Department, Prince of Wales Hospital (PWH) 2. Neurosurgery Department, PWH 3. Emergency Medicine Research Unit, Accident and Emergency Department, PWH
Introduction :
Modified Brain Injury Guideline (mBIG) has been implemented in the United States by which selected low risk traumatic brain injury (TBI) patients do not require a neurosurgical consult even with the presence of intracranial bleeding (mild complicated TBI), and the outcomes of improving safety and better allocation of medical resources have been promising. However, according to the current local clinical practice, many of these patients are being managed as in-patients in neurosurgical (NS) units, sometimes after consultations or even inter-hospital transfers. In PWH, 338 adult patients with TBI were admitted to NS Unit from June to December 2023, and 18% met the criteria for the lowest tier of risk (level 1 in mBIG). Specific protocols and consensus, as well as local data in safety and outcomes in managing this specific group of patients according to the mBIG risk stratification tool is lacking here in Hong Kong (HK).
Objectives :
To pilot a new protocol in managing patients with traumatic brain injury presented to Accident & Emergency department (A&E), Prince of Wales Hospital (PWH) in HK.
Methodology :
Adult patients aged over 18 with TBI were screened by a specific mBIG recruitment checklist. Patients with low-risk TBI features and without co-morbidities beyond the capacity of Emergency Medicine Ward (EMW) PWH were managed according to a new protocol jointly developed by A&E and Department of NS in PWH.
Result & Outcome :
Twenty-eight patients were recruited from June till end of November 2024. The average age was 73 years old, gender equally proportionate. The average length of stay (LOS) in A&E after seeing A&E doctors was around 2 hours. All recruited patients were admitted to EMW afterwards, with average LOS in EMW 1.40 days. Three patients needed care in addition to the mBIG protocol; two admitted to NS while the other one admitted to medical unit due to condition change. All recruited patients had NS follow-up after discharge, average follow-up time was 7 weeks. Four patients re-attended A&E after discharge, one admitted to EMW again, another admitted to medical unit, while the other two were discharged home. Fifty percent (14) of the recruited patients did not require further follow-up after first review in NS out-patient clinic.
