T. Nishimura1, S. Matsuyama1, S. Ishihara1, S. Nakayama1 1Hyogo Emergency Medical Center,Emergency And Critical Care,Kobe, HYOGO, Japan
Introduction: Craniotomy and evacuation is a still effective method for the patients with loss of consciousness due to intracranial hematoma. To gain favorable outcome and good neurological recovery, early diagnosis and early intervention are necessary. Usually, computed tomography is a helpful device to diagnose it, after stabilization of patient’s condition. From March 2017, our medical center has started Hybrid Emergency Room (Hybrid ER) strategy. Hybrid ER includes emergency department and radiology suite. This novel method is assumed to realize rapid image examination soon after admission safely. Therefore, we hypothesized that the usage of Hybrid ER for coma patients in need of evacuation of hematoma might lead to early diagnosis and intervention.
Methods: From January 2015 to June 2018, patients performed craniotomy and evacuation of hematoma were tabulated from medical record. Under 15-year-old, transferred from other hospital, planned operation, after severe sub arachnoid hemorrhage, trepanation and onset after arrival were excluded.
Results: 46 patients were enrolled; 29 in conventional group (emergency room group) and 17 in Hybrid ER group. There were 30 trauma patients and 16 non-trauma patients. Time interval from arrival of patient to computed tomography showed significant difference; 23.9 (8.2) min vs 10.4 (6.3) min respectively; p<0.001. Although interval time from arrival to craniotomy showed tendency of shortage, it was not different statistically; 154.4 (116.6) min vs 140 (64.5) min respectively; p=0.64. Patient prognosis were also similar; 6.9% vs 11.8%, p=0.57. Patients in Hybrid ER group tended to be avoided intubation even though they were under Glasgow Coma Scale 8 before computed tomography; 10/29 (34.5%) vs 4/17 (23.5%) respectively, p<0.01.
Conclusion: Our method could show significant shortage until diagnosis, however, could not improve the time until operation and patients’ outcome notably.