Neurologic Emergencies Presenting as Trauma Activations to an Urban Level I Trauma Center

Abstract

Background: It is speculated that there is overlap between neurologic emergencies and trauma, yet to date there has not been a study looking at the prevalence of neurologic emergencies amongst trauma activations.

Objectives: We sought to determine the prevalence of neurologic emergencies in patients presenting to a level I trauma center as trauma team activations (TTAs). We explored a subset of acute ischemic stroke patients to determine delays in management.

Methods: This was a retrospective review of trauma registry data capturing all TTAs at a level I trauma and stroke center from 2011 to 2016. Neurologic emergencies were defined as ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, or status epilepticus. Among patients diagnosed with acute ischemic strokes, we compared stroke metrics with hospital stroke data during the same period.

Results: There were 18,859 trauma activations during the study period, of which 117 (0.6%) had a neurologic emergency. There were 52 patients with ischemic stroke (45%), 39 with intracerebral hemorrhage (34%), 15 with subarachnoid hemorrhage (13%), and 10 with status epilepticus (9%). Among the 52 patients with ischemic stroke, 20 (38%) received intravenous thrombolysis. The median time to computed tomography scan was 23 min and the median time to thrombolysis (tissue plasminogen activator) was 60 min. When compared with non-TTA patients during the same time period, both median time to computed tomography scan and time to tissue plasminogen activator were similar (p = 0.16 and p = 0.6, respectively).

Conclusions: Neurologic emergencies, though relatively uncommon, do exist among TTAs. Despite the TTA, eligible patients met the benchmarks for acute stroke care delivery.

Keywords: intracerebral hemorrhage; neurologic; status epilepticus; stroke; trauma activation.