Clinical pathways improve care of patients with traumatic brain injury


WESTPORT, CT (Reuters Health) – The use of a recently developed multidisciplinary clinical pathway helps standardize and improve care in patients with traumatic brain injury, according to a report in the August issue of The Journal of Trauma Injury, Infection, and Critical Care.

Dr. Todd W. Vitaz of the University of Louisville School of Medicine in Kentucky and colleagues developed a time-independent, multidisciplinary clinical pathway to help guide the care of traumatic brain injury. They compared prospective data from 119 patients assigned to the traumatic brain injury clinical pathway (group 1) with data obtained from a database of 43 controls (group 2).

The researchers observed no differences between the groups in terms of age, Glasgow Coma Scale score at 24 hours, or Injury Severity Scores. No complications associated directly with the use of the clinical pathway were observed.

Patients in group 1 had significantly shorter hospital stays compared with patients in group 2, at 22.5 days and 31.0 days, respectively, p = 0.009. In addition, group 1 patients had significant decreases in the length of stay in the intensive care unit (16.8 days versus 21.2 days, respectively; p = 0.007) and the length of ventilator support (11.5 days and 14.4 days, respectively; p = 0.026).

Ninety-seven percent of the patients in group 1 underwent tracheostomy, compared with 88% of the patients in group 2, according to the report. In group 1 patients, this procedure was performed at a median of 4 days after injury. In group 2 patients, tracheostomy was performed at a median of 6 days after injury. Both groups had a high incidence of pneumonia, the authors explain, but there were fewer episodes in those managed with the clinical pathway.

"The clinical pathway facilitates patient progression and communication between various caregivers," Dr. Vitaz's group concludes. "This limits duplication of workloads and also decreases length-of-stay parameters and complications, therefore limiting costs."

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