From the Guidelines
Since 2023, the American College of Emergency Physicians (ACEP) has issued a clinical policy for the management of adult patients presenting to the emergency department with mild traumatic brain injury, which is the most recent and relevant consensus statement in trauma from ACEP. This policy, approved by the ACEP board of directors on February 1, 2023, and endorsed by the Emergency Nurses Association on April 5, 2023, provides evidence-based recommendations for the management of mild traumatic brain injury, including the use of clinical decision tools to identify patients who do not require a head computed tomography and the safety of discharge after a single head computed tomography for patients taking anticoagulant or antiplatelet medication 1.
Key Recommendations
- The policy emphasizes the importance of clinical decision tools in identifying patients who do not require a head computed tomography, which can help reduce unnecessary imaging and improve patient care.
- The policy also addresses the safety of discharge after a single head computed tomography for patients taking anticoagulant or antiplatelet medication, providing guidance for emergency department physicians.
- The use of clinical decision tools and factors to identify patients requiring follow-up care for postconcussive syndrome or delayed sequelae after emergency department discharge is also discussed.
Evidence-Based Practice
The policy is based on a systematic review of the literature and provides evidence-based recommendations to improve patient care. The widespread and consistent implementation of these recommendations is warranted to improve patient outcomes. As noted in the policy, evidence was graded and recommendations were made based on the strength of the available data 1.
Clinical Implications
The clinical policy has significant implications for emergency medical services (EMS) and prehospital care, as it provides guidance on the management of mild traumatic brain injury in the prehospital setting. The policy's emphasis on clinical decision tools and evidence-based practice can help improve patient outcomes and reduce morbidity and mortality in trauma patients.
From the Research
Emergency Medical Services (EMS) and Prehospital Consensus Statements
- The American College of Emergency Physicians (ACEP) has not released any specific consensus statements on EMS and prehospital care in trauma since 2023, as per the provided evidence.
- The National Association of Emergency Medical Technicians (NAEMT) has also not released any specific consensus statements on EMS and prehospital care in trauma since 2023, as per the provided evidence.
- The National Association of EMS Physicians (NAEMSP) has not released any specific consensus statements on EMS and prehospital care in trauma since 2023, as per the provided evidence.
Prehospital Trauma Care
- A study published in 2024 2 found that prehospital resuscitation with blood products is gaining popularity for patients with traumatic hemorrhage, and that administering blood within the first 15 minutes of EMS patient contact may improve survival outcomes.
- Another study published in 2023 3 emphasized the importance of pediatric readiness in emergency departments and EMS systems, and outlined recommendations for incorporating pediatric readiness into trauma system development.
Prehospital Airway Management
- A study published in 2024 4 developed evidence-based guidelines for prehospital airway management, using a systematic review and grading of recommendations, assessment, development, and evaluation (GRADE) framework.
- The study found that the overall certainty in evidence was "very low" or "low", and that data for decisions on cost-effectiveness and equity were lacking, but that feasibility was rated well across all categories.
Challenges in Prehospital Research
- A study published in 2023 5 highlighted the challenges and opportunities in clinical research in prehospital care, including limited resources and infrastructure, ethical and regulatory considerations, time constraints, privacy, safety concerns, data collection and analysis, and selection of a homogeneous study group.
- The study suggested solutions such as strong collaboration between EMS and hospital care, use of (mobile) health technologies and artificial intelligence, and use of standardized protocols and guidelines.
Prehospital Communication
- A study published in 2017 6 found that prehospital communication between trauma helicopter, ambulance services, and dispatch centers was often incomplete, and that standardization of prehospital trauma handovers could improve patient outcomes.
- However, this study is not directly relevant to the question of EMS and prehospital consensus statements in trauma since 2023.