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Kia āta kōwhiri Choosing Wisely

The Choosing Wisely campaign seeks to reduce harm from unnecessary and low-value tests and treatment.

The tool on this page is designed to help non-neuroscience centres capture patient data relating to serious traumatic brain injury (sTBI) for audit. 

Background

An sTBI can result in life-changing impairments for patients and affect their quality of life, capacity to work, participation in meaningful activities and relationships with others. 

Current evidence suggests a reduction in mortality for sTBI patients admitted to a neuroscience centre independent of a need for neurosurgical intervention. These patients benefit from the breadth and depth of specialist medical, nursing and allied health care found within these centres.  

In Aotearoa New Zealand, approximately half of sTBI patients are initially admitted to non-neuroscience centres. There is no national consensus on which patients should then be transported to specialist neuroscience centres, but data suggests there is significant regional variation in both access and outcome. 

Purpose of audit

The purpose of this audit is to identify those patients who fit the criteria for sTBI and who are not transported to a neuroscience centre for ongoing care, examine the factors contributing to this decision and the outcome for these patients. 

We will use the data to produce quarterly reports on the management of sTBI patients in Aotearoa New Zealand and investigate where opportunities for ongoing quality improvement work exist to reduce variation in care. 

Data security

Data uploaded through this online audit tool (form) is accessible only to those with administrator login access to the website (Health Quality & Safety Commission staff) and to selected Commission staff working directly on this project.  

Ethics

This audit has been assessed via the Health and Disability Ethics Committee (HDEC) screening tool as out of scope for HDEC review as per the Standard Operating Procedures for Health and Disability Ethics Committees (February 2023). 

Please complete this audit tool for all sTBI patients in your database NOT transferred to a Neuroscience Centre within 24 hours of arrival if;

  • GCS < 9

AND

  • Abnormal CT head (AISHEAD >2)

Questions marked * are required.


Definitions of terms used can be found at the bottom of this form.


Was the patient referred to a neuroscience centre? (Auckland, Starship, Waikato, Wellington, Christchurch, Dunedin)*
What was the MAIN reason the patient was not transferred to a neuroscience centre?*
Clinical criteria:
Where was the lack of resource?
Transport:
Were there any OTHER factors that contributed to the decision not to transfer the patient to a neuroscience centre? Please select all that apply.
Clinical criteria:
Where was the lack of resource?
Transport:
What was the patient’s destination from your ED?*
Neurosurgical consultation:*
Did the patient have post-traumatic amnesia (PTA)?*
Final disposition of patient:*

Definition of terms:

  • AISHEAD: Abbreviated Injury Scale (AIS) classification for injuries to the head region
  • Extracranial injury: Injuries sustained to body systems excluding the head
  • Post-traumatic amnesia: transient state of altered brain function that may follow traumatic injury
Last updated: 12th January, 2024