Impact of the hybrid emergency room system on long-term functional outcomes in severe traumatic brain injury.

BACKGROUND

Severe traumatic brain injury (TBI) remains a major cause of death and disability worldwide. Secondary brain injury due to hypoxia, hypotension, and intracranial hypertension worsens outcomes. The hybrid emergency room (ER) system integrates computed tomography, interventional radiology, and surgery in one suite, enabling an immediate diagnosis and intervention without patient transfer. This study evaluated its long-term effects on functional outcomes in severe TBI.

METHODS

This retrospective before-after study included patients with severe TBI (defined as Head Abbreviated Injury Scale ≥ 3, Glasgow Coma Scale [GCS] ≤ 8) admitted to Osaka General Medical Center between 2007 and 2019. Patients were classified into conventional (2007-2011) and hybrid ER (2011-2019) groups. The primary outcome was long-term functional status at follow-up assessed by the Glasgow Outcome Scale-Extended (GOS-E). The secondary outcome was GOS-E at hospital discharge. Multivariate logistic regression adjusted for age, GCS, and Injury Severity Score. An exploratory assessment of psychological and quality-of-life measures among long-term survivors was also performed.

RESULTS

A total of 127 patients were analyzed. The hybrid ER group had significantly shorter times to computed tomography (11 min vs. 27 min; p < 0.001) and surgery (48 min vs. 69 min; p < 0.001). Favorable outcomes (GOS-E ≥ 5) were more frequent in the hybrid ER group at discharge (37% vs. 16%) and follow-up (52% vs. 39%). After adjustment for major prognostic factors, management in the hybrid ER group was associated with favorable functional outcomes (adjusted OR 4.47; 95% CI 1.47-13.60; p = 0.008). The exploratory findings on psychological and quality-of-life outcomes were descriptive with no formal conclusions drawn, owing to the limited sample size and low response rate.

CONCLUSION

Hybrid ER management was associated with more favorable long-term functional outcomes compared with conventional management. The wide confidence intervals and differences in follow-up duration between groups preclude definitive conclusions; however, these findings are consistent with a sustained benefit of early integrated trauma care and warrant further prospective investigation.