Introduction: Mild traumatic brain injury (mTBI) is a common diagnosis requiring supportive care and observation. Frequently, these patients are admitted to an intensive care unit (ICU) or intermediate care unit (IMU) despite the rare occurrence of neurological deterioration and surgical intervention. ICU admission may cause bed capacity issues and increased health care costs. This study investigates the safety and cost-efficiency of our novel mTBI admission protocol compared to historical controls.
Methods: From February 2016 through July 2017, 779 consecutive mTBI patients were admitted to our level 1 trauma center. Using the new protocol, patients were stratified into risk categories, and the admission location was determined. We recorded mortality, neurological morbidity, bed admission acuity, upgrades in level of care, and neurological readmission in 30 days. The bed acuity included ICU, IMU, and floor. A 2-year historical cohort was used as a comparison.
Results: Of the mTBI study cohort, 352 patients met our inclusion criteria, and the historical cohort had 917 patients. We had no mortalities in our study group. We observed 3 (< 0.01%) upgrades in level of care, all of which were not for neurological reasons. Neurological readmissions within 30 days occurred in 4 (0.02%) patients. The percentage of ICU admissions decreased significantly from 70% in the historical population to 24% (p-value < 0.001). The average cost of the first day of admission decreased from $5,243 to $3,750 (p-value < 0.001).
Conclusions: The data show that our new admission protocol does not compromise patient safety or outcome. This protocol decreased the ICU admissions as well as cost and may potentially decrease length of stay and incidence of medical complications related to ICU level of care.
Patient Care: Valid, safe protocols have reliably shown to improve patient outcomes in modern medicine. Our protocol decreases ICU admissions and, potentially, LOS. Thus, the incidence of medical complications associated with ICU admission and a longer LOS are decreased. Additionally, the decreased cost of care potentially lessens the financial burden on the patient.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Discuss the increased costs and bed-capacity issues related to mTBI patients, 2) Describe the cost benefits of a novel mTBI protocol, and 3) Identify potential areas for further improvement in our mTBI without an increase in morbidity and mortality.