Journal article
Assessment of safety and effectiveness of non-neurosurgical management for minimal traumatic brain injury (TBI)
Injury, Vol.54(1), pp.82-86
01/2023
DOI: 10.1016/j.injury.2022.08.009
PMID: 36028374
Abstract
•A minimal TBI protocol implemented in level 1 trauma center was found to be safely reduce neurosurgical consultation. Within the study period, there was a significant reduction in neurosurgery consults with no significant change in neurosurgery procedures, operations, or ED revisits.
Patients with mild traumatic brain injury (TBI) and intracranial hemorrhage often receive neurosurgical consultation. However, only a small proportion of patients require intervention. Our hypothesis is that low-risk minimal TBI patients managed without immediate neurosurgical consultation will have a reasonable safety and effectiveness outcome profile.
A non-neurosurgical management protocol for adult minimal TBI was implemented at a level I trauma center as an interdisciplinary quality-improvement initiative in November 2018. Minimal TBI was defined as Glasgow Coma Scale (GCS) of 15 secondary to blunt mechanism, without anticoagulant or antiplatelet therapy, and isolated pneumocephalus and/or traumatic subarachnoid hemorrhage on head CT imaging. Safety was assessed by in-hospital mortality, neurosurgical interventions, and ED revisits within two weeks of discharge. Effectiveness was assessed by neurosurgical consult rate and length of stay. Outcomes were compared 8-months pre- and post-protocol implementation.
A total of 97 patients were included, of which 49 were pre-protocol and 48 were post-protocol There was no difference in rates of in-hospital mortality [0 (0%) vs 0 (0%)], neurosurgical procedure [1 (2.1%) vs 0 (0%)], operations [0 (0%) vs 0 (0%)], and ED revisits [1 (2.0%) vs 2 (4.2%), p = 0.985] between the periods. There was a significant reduction in neurosurgical consults post-protocol implementation (92% vs 29%, p<0.001).
A protocol for minimal TBI patients effectively reduced neurosurgical consultation without changes in safety profile. Such an interdisciplinary management protocol for low-risk neurotrauma can effectively utilize the neurosurgery consult services by stratifying neurologically stable TBI patient.
Details
- Title: Subtitle
- Assessment of safety and effectiveness of non-neurosurgical management for minimal traumatic brain injury (TBI)
- Creators
- Jeffrey W. Chen - Vanderbilt University School of MedicineAaron Yengo-Kahn - Vanderbilt University Medical CenterSilky Chotai - Vanderbilt University Medical CenterAkshay Bhamidipati - Vanderbilt University School of MedicineCandice Smith - Vanderbilt University Medical CenterPhilip Davis - Vanderbilt University School of MedicineRebecca A. Reynolds - Vanderbilt University Medical CenterMary Peyton Boyd - Vanderbilt University School of MedicineTyler W. Barrett - Vanderbilt University School of MedicineElizabeth S. Compton - Vanderbilt University Medical CenterBradley M. Dennis - Vanderbilt University School of MedicineMichael S. Norris - Vanderbilt University Medical CenterMayur B. Patel - Vanderbilt University School of MedicineJacob P. Schwarz - Vanderbilt University School of MedicineNicholas R. Thomason - Vanderbilt University Medical CenterReid C. Thompson - Vanderbilt University School of MedicineOscar D. Guillamondegui - Vanderbilt University School of Medicine
- Resource Type
- Journal article
- Publication Details
- Injury, Vol.54(1), pp.82-86
- Publisher
- Elsevier Ltd
- DOI
- 10.1016/j.injury.2022.08.009
- PMID
- 36028374
- ISSN
- 0020-1383
- eISSN
- 1879-0267
- Grant note
- DOI: 10.13039/100007206, name: Vanderbilt Institute for Clinical and Translational Research; DOI: 10.13039/100000002, name: National Institutes of Health, award: AG058639, GM120484, UL1 TR000445; DOI: 10.13039/100006108, name: National Center for Advancing Translational Sciences
- Language
- English
- Date published
- 01/2023
- Academic Unit
- Neurosurgery
- Record Identifier
- 9984446422302771
Metrics
18 Record Views