Current challenges and future opportunities in on-scene prehospital triage of traumatic brain injury patients: A qualitative study in the UK

Abstract

Introduction

Traumatic brain injury (TBI) presents significant challenges in prehospital care, particularly during on-scene triage, where accurate decision-making is crucial for improving patient outcomes. This study, part of a mixed-methods project, aims to explore these challenges and identify gaps in current on-scene triage practices. Additionally, it seeks to understand paramedics’ perspectives on potential diagnostic tools such as brain biomarkers, near-infrared spectroscopy, and decision aids.

Methods

This study involved conducting semi-structured interviews by video conference, including interviews with paramedics of various experience levels who were recruited from UK ambulance trusts. The interviews were guided by a predeveloped and piloted topic guide. The interviews were audio-recorded, transcribed, and analysed using a thematic analysis approach.

Results

Between June and December 2022, twenty participants (15 males and 5 females) with 4 to 24 years of experience were interviewed. Four key themes were identified. Theme 1, “Challenges in TBI Recognition,” highlighted difficulties in identifying non-obvious TBI, especially in older adults or patients with comorbidities, and differentiating TBI from other conditions. Theme 2, "Need for Specific Triage and Diagnostic Tools," emphasised paramedics' need for a simple, evidence-based head injury-specific triage tool, as they felt that current tools lack the necessary specificity. Participants also highlighted the potential of new diagnostic technologies to improve decision-making. Theme 3, “Need for Evidence to Support Diagnostic Tools,” stressed the importance of clinical effectiveness, feasibility, and cost before implementing new diagnostic technologies. Theme 4, “Implementation Requires Planning and Training,” highlighted the need for effective implementation strategies, as well as adequate and ongoing training to ensure proficiency and proper use in the prehospital setting.

Conclusions

This study provides critical insights into the complexities of on-scene prehospital triage for patients with suspected TBI. Key recommendations include developing specific triage tools, exploring advanced technologies to support on-scene decision-making, enhancing paramedic training on TBI recognition, and addressing both barriers and facilitators to the implementation of new diagnostic technologies.