Toward a Better Care Pathway for Minor Head Injury
By Diku Mandavia, MD, FACEP on June 13, 2022

Toward a Better Care Pathway for Minor Head Injury

Ninety-five percent of head injured patients that visit the Emergency Department (ED) are considered to be “mild.” Many hospitals employ a fast-track, or similar pathway, for these patients. Their injury is not life threatening, they do not require the resources of more acute patients, and therefore in theory they can be quickly evaluated and discharged.

The benefits of a fast-track approach are well researched:

  • Shorter wait time
  • Shorter ED length of stay
  • Decreased patients leaving without being seen
  • Improved patient experience

In fact, a study by Hwang and colleagues found that employing a Fast Track area for low acuity patients can more than double the odds of significant improvement in patient satisfaction metrics.

The current standard of care for 80% of these patients, whether in fast-track or not, is to order a head CT to rule out an intracranial bleed. Additionally, many head injured patients expect a CT during the ED visit. While having a standard pathway can feel efficient and aligns with a fast-track approach, the reality for many head injured patients is that this is not a quick experience.

Head injured patients are often in “fast-track” they are also “last in line” for CT resources increasing wait time and are often bumped by more serious cases. Furthermore, the overwhelming majority of these scans will be negative for intracranial brain bleeds (91%).

Can new tools reduce the length of stay for head injured  patients? Register for BrainScope's free webinar to find out.

Michelson and colleagues found that head injured patients that receive a CT scan can spend 6 or more hours in the ED. Much of this time is spent waiting – waiting to be assessed, waiting for transfer to CT, waiting for return transfer, waiting for results to be read, waiting for the ED physician to review the results and determine next steps.

Patient care, safety, and satisfaction are profoundly impacted by unnecessary radiation (a head CT is the equivalent of approximately 400 dental x-rays), long wait times, high out-of-pocket costs, and an unmet need for an objective concussion assessment. For these reasons and others, the American College of Emergency Physicians (ACEP) has partnered with Choosing Wisely® to provide a list of recommendations of how to avoid unnecessary procedures and associated costs. Avoidance of head CTs is the number one recommendation.

A point of care decision support tool, BrainScope can help rule out the need for a head CT within 15-20 minutes. The assessment can be run by a nurse, a technician, or another identified clinical/non-clinical member of the staff. The results do not require specialized physician interpretation.

Less waiting for the test, less waiting for results means less  time spent in the ED,and therefore a better patient experience.

BrainScope offers EDs an innovative option to better align with an expedited approach and avoid unnecessary head CTs. The head injury care pathway has not changed in decades and we are trapped using the same workup for all patients despite their presenting condition. The BrainScope device can be used on alert patients presenting to the ED within a 72-hour window post-injury, a period within which the vast majority of patients seek care.

A BrainScope assessment also answers the real question many patients come to the ED for “Do I have a concussion?” Unknown to many, a head CT cannot detect concussion—concussed patients are often sent home from the ED without the information they need to start appropriate care. Moreover, the results of concussion tests that do exist are highly subjective and can lead to misclassification up to half of the time.

The lack of a standardized concussion assessment protocol or referral pathway can have both short and long-term consequences because early evaluation and intervention is paramount to the care of head injured patients and can lead to shorter recovery time.

BrainScope’s breakthrough technology combines AI and machine learning to derive proprietary, well-validated algorithms to provide objective, actionable results on the likelihood of a brain bleed and brain function impairment. To date, BrainScope is the only FDA cleared medical device to offer an assessment of both structural and functional head injuries. Both assessments are completed and reported simultaneously.

Adopting a handheld point of care decision support tool to rapidly triage head injured patients for the likelihood of intracranial hemorrhage and concussion is an important starting point in improving the current state of head injury diagnosis and care.

Learn more about BrainScope.

Published by Diku Mandavia, MD, FACEP June 13, 2022