• Hannah Trebilcock.
• South Western Ambulance Service NHS Foundation Trust, Exeter, UK.
• Emerg Med J. 2015 Jun 1;32(6):503-4.

BackgroundIdentification of TBI is extremely difficult and is often missed in the pre-hospital setting. Major trauma triage tool (MTTT) criteria specifies the suspicion of an open or depressed skull fracture as indicating a major trauma patient. However, it is often the case that patients with TBI recorded on the Trauma Audit and Research Network (TARN) data with an ISS>15, indicating major trauma, are not identified by the MTTT. This results in many patients with significant TBI being undertriaged and not receiving definitive care as rapidly as possible. Early intervention in patients suffering TBI is essential in ensuring the best possible outcome. A retrospective clinical record review is being conducted to establish whether there are clinical or behavioural indicators of TBI that could be incorporated into clinical guidance to improve identification.MethodThe sample consists of 193 patients on the trauma database who have sustained a head injury between January-March 2014. For each of these incidents the patient clinical record (PCR) has been reviewed to provide data on many different demographic, physiological and behavioural aspects. All data has now been entered ready for analysis. Using the TARN data, patients will be divided into 2 groups. The experimental group will consist of those patients who have significant head injuries recorded by TARN. The control group will include the patients who have been identified as suspected major trauma with a head injury but have no corresponding injuries recorded on TARN.ResultsIt is anticipated that at least one demographic, physiological or behavioural aspect will be a reliable indicator of TBI.ImplicationsThis retrospective clinical record review could greatly improve the identification of major trauma patients who have sustained a serious head injury. In turn this will mean more patients being appropriately conveyed to the MTC where specialised neurosurgeons are available.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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