Journal article
The acute care surgery model: Managing traumatic brain injury without an inpatient neurosurgical consultation
The journal of trauma and acute care surgery, Vol.75(1), pp.102-105
07/01/2013
DOI: 10.1097/TA.0b013e3182946667
PMID: 23778447
Abstract
BACKGROUND: Neurosurgical services are a limited resource and effective use of them would improve the health care system. Acute care surgeons (ACS) are accustomed to treating mild traumatic brain injury (TBI) including those with minor radiographic intracranial injuries. We hypothesized that ACS safely manage mild TBI with intracranial hemorrhage (ICH) on head computed tomographic (CT) scan without neurosurgical consultation (NC).
METHODS: We performed a retrospective analysis on all TBI patients with positive findings on head CT scan managed without NC during a 2-year period. Propensity scoring matched NC to no-NC patients on a 1: 2 ratio for Glasgow Coma Scale (GCS) score, head Abbreviated Injury Scale (h-AIS) score, neurological examination, age, Injury Severity Score (ISS), findings of initial head CT scan including type and size of ICH.
RESULTS: A total of 270 patients with mild TBI and positive CT scan findings were included (90 with NC and 180 without NC). Sixty-three percent were male, and mean (SD) age was 39 (25) years. The median GCS was 15 (13-15), and the h-AIS score was 2 (1-3). In both groups, there was no neurosurgical intervention, in-hospital mortality, or 30-day readmission. In the no-NC group, 8% of the patients had postdischarge emergency department (ED) visits compared with 4% of the NC group (p = 0.5). All patients with postdischarge ED visits in both groups were discharged home from the ED.
CONCLUSION: ACS can manage mild TBI with ICH without obtaining an inpatient NC. Further guidelines should be established to help identify which patients meet criteria to be safely managed without NC. (J Trauma Acute Care Surg. 2013; 75: 102-105. Copyright (C) 2013 by Lippincott Williams & Wilkins)
Details
- Title: Subtitle
- The acute care surgery model: Managing traumatic brain injury without an inpatient neurosurgical consultation
- Creators
- Bellal Joseph - University of ArizonaHassan Aziz - University of ArizonaMoutamn Sadoun - University of ArizonaNarong Kulvatunyou - University of ArizonaAndrew Tang - University of ArizonaTerence O'Keeffe - University of ArizonaJulie Wynne - University of ArizonaLynn Gries - University of ArizonaDonald J. Green - University of ArizonaRandall S. Friese - University of ArizonaPeter Rhee - University of Arizona
- Resource Type
- Journal article
- Publication Details
- The journal of trauma and acute care surgery, Vol.75(1), pp.102-105
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1097/TA.0b013e3182946667
- PMID
- 23778447
- ISSN
- 2163-0755
- eISSN
- 2163-0763
- Number of pages
- 4
- Language
- English
- Date published
- 07/01/2013
- Academic Unit
- Surgery
- Record Identifier
- 9984701642402771
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