• Jeffrey W Chen, Aaron Yengo-Kahn, Silky Chotai, Akshay Bhamidipati, Candice Smith, Philip Davis, Rebecca A Reynolds, Mary Peyton Boyd, Tyler W Barrett, Elizabeth S Compton, Bradley M Dennis, Michael S Norris, Mayur B Patel, Jacob P Schwarz, Nicholas R Thomason, Reid C Thompson, and Oscar D Guillamondegui.
• Vanderbilt University School of Medicine, Nashville, TN, United States. Electronic address: jeffrey.w.chen@vanderbilt.edu.
• Injury. 2023 Jan 1; 54 (1): 828682-86.

BackgroundPatients 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.MethodsA 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.ResultsA 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).ConclusionA 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.Copyright © 2022. Published by Elsevier Ltd.

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