8 minutes in the emergency department

Treating traumatic brain injury

On Dec. 9, 2010, a 5-year-old girl arrived in the emergency department of Saint Marys Hospital, one of Mayo Clinic's hospitals in Rochester, Minn. Diagnosed with an epidural hematoma, she had been transported by helicopter from a hospital in Mankato, 70 miles away.

The pediatric trauma team immediately performed primary and secondary surveys, a chest X-ray and blood draw. Eight minutes later, the young patient was wheeled into the operating room. "Advanced technology and an integrated system of care make such rapid interventions possible," says pediatric surgeon D. Dean Potter, M.D., trauma director for the Level I Pediatric Trauma Center at Saint Marys Hospital.

Time is life

Traumatic brain injury (TBI) is the leading cause of death and disability in children under 14. Rapid evaluation and intervention are essential for patients with TBI. Death can occur within two to three hours of an injury.

According to pediatric surgeon Nicholas M. Wetjen, M.D., "Outcomes improve when treatment is initiated in the first, golden hour after an accident. Although that wasn't possible in this case, electronically shared diagnostic images and a coordinated triage and interfacility transport system made a critical difference."

Minute by minute

The young patient's journey to Mayo began during gym class, when a ball struck the side of her head. She fell to the ground, vomited and may have briefly lost consciousness. She was evaluated at Mayo Clinic Health System in Mankato, a Level III Trauma Center.

A CT scan of the patient's head performed at 2:20 p.m. showed blood accumulating on the right side of her skull. Trauma specialists in Mankato recognized the need for specialized care at a Level I Pediatric Trauma Center and had the patient ready for transfer in less than six minutes.

"We received the page about this child at 2:32 p.m.," Dr. Potter says. "Dr. Wetjen and I logged on an image-viewing device and reviewed the scan of her head performed in Mankato. We made the decision to have the hematoma surgically removed. Then our goal was to get her to the operating room as quickly as possible. When the helicopter landed at 3:54 p.m., the pediatric trauma team and operating room were ready."

Dr. Potter says that this case exemplifies how electronic file transfer systems not only save time but also can improve the way injured children are cared for overall. "It would have taken 20 or 30 minutes longer if we'd had to do another scan here and the patient would have been exposed to more radiation," says Dr. Potter. "Instead, we had everything ready before she arrived. The importance of rapid communication and online viewing can't be overestimated."

Donald Jenkins, M.D., a trauma surgeon and trauma director for the Level I Trauma Center at Saint Marys Hospital, adds that Mayo Clinic has adopted standard trauma imaging techniques systemwide. "The contrast, timing of contrast and imaging technique are all done so that electronically transmitted images have the same diagnostic quality as images obtained at Saint Marys," says Dr. Jenkins.

He also emphasizes that Mayo Clinic's "coordinated, regionalized triage system is an equally vital component of trauma care. "We rely on specialists at Level III and IV centers in our trauma area to follow these guidelines to provide lifesaving interventions, to quickly recognize the need for transfer and to initiate it as soon as possible. Time is life."

Follow-up

The 5-year-old patient left the hospital three days after trauma specialists successfully evacuated the hematoma. Since then, the patient had a TBI consult and was seen by Mayo Clinic's brain rehabilitation team. According to Dr. Wetjen, "She's doing great."