Assessment of safety and effectiveness of non-neurosurgical management for minimal traumatic brain injury (TBI). Issue 1 (January 2023)

• Record Type: Journal Article
• Authors: Chen, Jeffrey W.; Yengo-Kahn, Aaron; Chotai, Silky; Bhamidipati, Akshay; Smith, Candice; Davis, Philip; Reynolds, Rebecca A.; Boyd, Mary Peyton; Barrett, Tyler W.; Compton, Elizabeth S.; Dennis, Bradley M.; Norris, Michael S.; Patel, Mayur B.; Schwarz, Jacob P.; Thomason, Nicholas R.; Thompson, Reid C.; Guillamondegui, Oscar D.
• Is Part Of: Injury. Volume 54:Issue 1(2023)
• Page Start: 82
• Page End: 86
• Publication Date: 2023-01
• Subjects: Neurotrauma -- Traumatic brain injury -- Mild traumatic brain injury -- Glasgow Coma Scale -- Quality improvement; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2022.08.009
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: 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. Abstract: Background: 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. Methods: 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. Results: 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). Conclusion: 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.