Implementation of a biomarker-based algorithm for the management of patients with mild traumatic brain injury in the emergency department: a quasi-experimental study

Abstract

Background: mild traumatic brain injury (mTBI) is a common presentation in emergency rooms (ER), often requiring cranial computed tomography (cCT) to rule out intracranial injuries. However, excessive reliance on cCT and confusion in their criteria to be performed can result in unnecessary radiation exposure, increased healthcare costs, and prolonged ER stays. Recent advances suggest that blood TBI biomarkers, such as GFAP and UCH-L1, may represent an accurate screening tool to identify patients at low risk of intracranial injuries, reducing cCT scan utilization. Nevertheless, these have yet to be implemented into clinical practice guidelines. Objectives: to evaluate the implementation of a biomarker-based diagnostic algorithm for mTBI management in the ER of a tertiary hospital. We aim to assess its impact on the proportion of cCT performed and the length of ER stay, while ensuring patient safety. Design: a quasi-experimental, pre-post implementation study will be conducted in a tertiary hospital. The pre-implementation period will include patients managed using standard protocols without biomarkers. The post-implementation period will introduce the new TBI biomarker-based algorithm. Participants and methods: 225 patients will be included in each group using a consecutive sampling method and a recruitment period of 8 months. Patients aged ≥18 years presenting within 12 hours of a head trauma will be included. Data will be collected retrospectively from the existing database of the hospital for the first group and prospectively during visits to the ER for the second group. Primary outcomes will be the proportion of cCT performed and ER time of stay. Secondary outcomes will include safety indicators such as reattendance rates and mortality related to mTBI. Results will be analyzed and compared by a statistician