Medical Student – University of Queensland
Dr Patrick Biggins completed his PhD in 2016 in the laboratory of A/Prof Marc Ruitenberg (University of Queensland), investigating neuro-inflammation following traumatic spinal cord injury. He then commenced his Doctor of Medicine studies at the University of Queensland. While undertaking these studies, he has shifted the focus of his research, and is currently collaborating with clinicians and researchers at the Royal Brisbane and Women’s Hospital and Jamieson Trauma Institute on an investigation looking at time to surgical treatment as a determinant of outcome in severe traumatic brain injury.
Time to surgical treatment as a determinant of outcome in severe traumatic brain injury: a systematic review
Severe Traumatic Brain Injury (sTBI) (≤8 initial score on the Glasgow Coma Scale) is a devastating event, often causing significant long-term neurological, cognitive and lifestyle impairment to patients, with associated downstream effects on their families and broader society. Given the significant burdens associated with sTBI, it is imperative that optimised clinical practice guidelines be implemented. Presently, best clinical practice operates on a 4-hour window from time-of-injury to time-of-(neuro-)surgical intervention. The study from which this rule was derived was performed nearly four decades ago – an era before widespread availability of CT scanning, and different intercurrent prehospital and critical care processes. Additionally, this study contained a relatively small patient cohort (n = 82) and was limited to acute subdural haemorrhages. By not including other causes of brain injury, the broader applicability of the study findings is limited. Therefore, it is reasonable to question the validity of this 4-hour rule. To investigate this issue, a systematic review was conducted using PubMed. This literature search revealed numerous conflicting studies, with some reporting a beneficial, detrimental or absence of relationship between this 4-hour rule and outcome of sTBI patients. This presentation will discuss these contradictions and a potential study format that would address this issue in an Australian healthcare setting.