Response to performance of the Hull Salford Cambridge Decision Rule: the start of the traumatic brain injury (TBI) assessment and recovery journey.

Abstract

In the CENTER-TBI core cohort, 30% of patients with TBI managed and discharged from the ED had persistent disability and a Glasgow Outcome Scale score of less than eight months following injury.3 However, initial CT findings in mTBI are not necessarily predictive of longer term disability and functional impairment following injury.4 5 Therefore, our study cohort of patients with mTBI with injuries identified on CT imaging may not be at higher risk of longer term functional impairment and need for rehabilitation than other patients with mTBI. The primary purpose of the risk assessment and selection of patients for CT imaging who have sustained head trauma in the ED is to identify potentially life-threatening injuries which may require neurosurgical intervention and admission to hospital due to the risk of deterioration.6 The aim of our work is to help clarify which injuries identified by CT imaging are in this category based on both patient characteristics and CT findings. [...]new biomarkers are welcome for both ‘indications for admission to hospital’ and ‘assessment for risk of post head injury symptoms’, which also are currently being reviewed by the National Institute for Health and Care Excellence Head Injury Guideline Update Committee.7 Although it is important that patients at risk of long-term sequelae from their injuries are identified and receive appropriate rehabilitation, it is currently difficult to identify such patients in the acute phase of their injury.8 Inpatient hospital admission has associated costs and risks, which have been exacerbated by the COVID-19 pandemic and current large increase in demand for urgent and emergency care services.