Citation

Lewis PR, Dunne CE, Wallace JD, Brill JB, Calvo RY, Badiee J, Sise MJ, Bansal V, Sise CB, Shackford SR. J. Trauma Acute Care Surg. 2017; 82(4): 776-780.

Affiliation

From the Trauma Service, Scripps Mercy Hospital, San Diego, California.

Copyright

(Copyright © 2017, Lippincott Williams and Wilkins)

DOI

10.1097/TA.0000000000001388

PMID

28099375

Abstract

BACKGROUND: The Brain Trauma Foundation guidelines provide indications for neurosurgical intervention in traumatic brain injury (TBI) with moderate or severe intracranial hemorrhage (ICH). In TBI patients with less severe ICH, the utility of neurosurgical consultation remains unclear. We sought to determine if routine neurosurgical consultation is necessary for mild blunt TBI patients with ICH.

METHODS: A retrospective cohort study was conducted on 500 consecutive blunt TBI patients aged 15 years or older with Glasgow Coma Scale score ≥13 and ICH on initial head computed tomography (CT) admitted to a Level 1 trauma center over 28 months. Outcomes were neurosurgical intervention (craniotomy, craniectomy, ventriculostomy, or intracranial pressure monitor placement) and in-hospital mortality. Statistical significance was assessed at a p<0.05.

RESULTS: Of 500 patients, 49 (9.8%) underwent neurosurgical intervention. Neurosurgical intervention was more frequent in males (75.5% vs. 61.2%, p=0.049), patients with higher head-AIS (4.7 vs. 3.8, p<0.0001), an abnormal initial neurological examination (30.6% vs. 12.6%, p=0.001), or skull fracture (28.6% vs. 16.0%, p=0.026), and was associated with higher mortality (8.2% vs. 2.0%, p=0.010). Neurosurgical intervention was not associated with intoxication, pre-injury antiplatelet/anticoagulation agents, or progression of ICH on second head CT. Neurosurgical consultation was documented in 466 patients (93.2%). For patients without neurosurgical intervention, consultation did not change management.

CONCLUSIONS: Routine neurosurgical consultation for blunt TBI with ICH seems unnecessary, regardless of intoxication or pre-injury antiplatelet or anticoagulation therapy. A more selective approach is warranted to decrease hospital charges and optimize use of neurosurgical consultation. LEVEL OF EVIDENCE: Level III, care management.

Language: en