Management of Adult Closed Head Injury in Rural Queensland Without Hospital-Based CT: A Retrospective Cohort Study

Abstract

Objective

To describe management, imaging pathways and systems challenges for adult closed head injury presentations to a rural Queensland emergency department without hospital-based CT.

Methods

A retrospective cohort study was conducted at Dalby Hospital from January 2022 to January 2023. Adult patients presenting with closed head injury were identified through manual Emergency Department Information System review. Demographic, clinical, imaging, disposition and documentation variables were extracted from medical records. CT access was categorised as local offsite private radiology or interhospital transfer.

Results

A total of 118 patients were included; 73/118 (61.9%) were male and mean age was 48.6 years. CT head was performed in 60/118 (50.8%) patients. Of these, 30/60 (50.0%) underwent CT through an offsite private radiology provider and 30/60 (50.0%) required interhospital transfer. Intracranial haemorrhage was identified in 9/60 (15.0%) imaged patients, comprising 7 subdural and 2 subarachnoid haemorrhages. Documentation of observation and discharge advice was variable. A planned period of observation was documented in 55/118 (46.6%) cases. Among patients discharged from the emergency department or short-stay unit, written patient information was documented in 36/72 (50.0%), red-flag discussion in 32/72 (44.4%), and no-driving advice in 5/72 (6.9%).

Conclusion

Patients with closed head injury in this rural emergency department had substantial neuroimaging needs despite the absence of hospital-based CT. Imaging was obtained through either local offsite private radiology or interhospital transfer, requiring clinicians to consider both imaging need and pathway safety. Variable documentation of observation and discharge advice highlights an opportunity to strengthen safety-netting in rural head injury care.