Prospective validation of the brain injury guidelines: Managing traumatic brain injury without neurosurgical consultation

Bellal Joseph, Hassan Aziz, Viraj Pandit, Narong Kulvatunyou, Moutamn Sadoun, Andrew Tang, Terence OKeeffe, Lynn Gries, Donald J. Green, Randall S. Friese, Michael G. Lemole, Peter Rhee

Research output: Contribution to journalArticlepeer-review

51 Scopus citations


Background: To optimize neurosurgical resources, guidelines were developed at our institution, allowing the acute care surgeons to independently manage traumatic intracranial hemorrhage less than or equal to 4 mm. The aim of our study was to evaluate our established Brain Injury Guidelines (BIG 1 category) for managing patients with traumatic brain injury (TBI) without neurosurgical consultation.

Methods: We formulated the BIG based on a 4-year retrospective chart reviewof all TBI patients presenting at our Level 1 trauma center. We then prospectively implemented our BIG 1 category to identify TBI patients that were to be managed without neurosurgical consultation (No-NC). Propensity scoring matched patients with No-NC to a similar cohort of patients managed with NC before the implementation of our BIG in a 1:1 ratio for demographics, severity of injury, and type and size of intracranial hemorrhage. Primary outcome measure was need for neurosurgical intervention and 30-day readmission rates.

Results: A total of 254 TBI patients (127 of NC and 127 of No-NC patients) were included in the analysis. The mean (SD) age was 40.8 (22.7) years, 63.4% (n = 161) were male, median Glasgow Coma Scale (GCS) score was 15 (range, 13Y15), and median head Abbreviated Injury Scale (AIS) score was 2 (range, 2Y3). There was no neurosurgical intervention or 30-day readmission in both the groups. In the No-NC group, 3.9% of the patients had postdischarge emergency department visits compared with 4.7% of the NC group (p = 0.5). All patients were discharged home from the emergency department.

Conclusion: We validated our BIG and demonstrated that acute care surgeons can effectively care for minimally injured TBI patients with good outcomes.Anational multi-institutional prospective evaluation iswarranted.

Original languageEnglish (US)
Pages (from-to)984-988
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Issue number6
StatePublished - Dec 11 2014
Externally publishedYes


  • Acute care surgeons
  • Brain injury guidelines
  • Management of traumatic brain injury
  • Neurosurgical consultation
  • Neurosurgical intervention

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine


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