Patients suffering traumatic brain injury: characteristics, primary referral and mortality – A population-based follow-up study

Abstract Background Traumatic brain injury is a potential high-risk condition. Appropriate care pathways, including prehospital triage and primary referral to a specialized neurosurgical center, improves neurological outcome and survival. The aim of this study was to examine TBI patient and injury characteristics, the way of entering into the health care system, place of primary referral and the associated 30-day and 1-year mortality rates in TBI patients with confirmed intracranial lesions. Methods This was a retrospective observational population-based follow-up study conducted in Central Denmark Region from 1 February 2017 to 31 January 2019. We included all hospital contacts of patients ascribed a predefined TBI ICD-10 diagnosis code in the Danish National Patient Register. The obtained TBI cohort was merged with prehospital data from the Prehospital Emergency Medical Services, Central Denmark Region, and vital status from the Danish Civil Registration System. Binary logistic regression analysis of mortality was applied. Results A total of 5,257 first TBI hospital contacts were included in the cohort. Of these, 1,430 (27.2%) entered the health care system by 112-call. TBI patients triaged by 112-call were more likely to receive the highest level of emergency response, second-tier resources and were more frequently referred directly to a specialized center than patients entering through general practioner or other health care personnel. In the subgroup of 1188/5257 (22.4%) patients with confirmed intracranial lesions, we found no difference in risk ratio of 30-day (RR 1.04 (95%CI 0.65 − 1.63)) or 1-year (RR 0.96 (95%CI 0.72–1.25)) all-cause mortality between patients primarily referred to a regional hospital or specialized center when adjusting for age, sex, comorbidities, antiplatelet/-coagulant treatment and type of intracranial lesions. Conclusion TBI patients mainly enter the health system by contact to general practitioner or other health care professionals, but patients entering through 112-call are more frequently triaged directly to specialized center. We were unable to demonstrate any significant difference in adjusted 30-day and 1-year mortality according to primary referral to a specialized center or not.