The acute care surgery model

Managing traumatic brain injury without an inpatient neurosurgical consultation

Bellal Joseph, Hassan Aziz, Moutamn Sadoun, Narong Kulvatunyou, Andrew Tang, Terence OKeeffe, Julie Wynne, Lynn Gries, Donald J. Green, Randall S. Friese, Peter Rhee

Research output: Contribution to journalArticle

30 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)102-105
Number of pages4
JournalJournal of Trauma and Acute Care Surgery
Volume75
Issue number1
DOIs
StatePublished - Jul 1 2013
Externally publishedYes

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Inpatients
Referral and Consultation
Brain Concussion
Intracranial Hemorrhages
Abbreviated Injury Scale
Hospital Emergency Service
Glasgow Coma Scale
Head
Craniocerebral Trauma
Traumatic Brain Injury
Injury Severity Score
Neurologic Examination
Hospital Mortality
Guidelines
Delivery of Health Care
Wounds and Injuries
Surgeons

Keywords

  • Acute care surgery model
  • Intracranial hemorrhage
  • Mild traumatic brain injury
  • Neurosurgical consultation

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

The acute care surgery model : Managing traumatic brain injury without an inpatient neurosurgical consultation. / Joseph, Bellal; Aziz, Hassan; Sadoun, Moutamn; Kulvatunyou, Narong; Tang, Andrew; OKeeffe, Terence; Wynne, Julie; Gries, Lynn; Green, Donald J.; Friese, Randall S.; Rhee, Peter.

In: Journal of Trauma and Acute Care Surgery, Vol. 75, No. 1, 01.07.2013, p. 102-105.

Research output: Contribution to journalArticle

Joseph, B, Aziz, H, Sadoun, M, Kulvatunyou, N, Tang, A, OKeeffe, T, Wynne, J, Gries, L, Green, DJ, Friese, RS & Rhee, P 2013, 'The acute care surgery model: Managing traumatic brain injury without an inpatient neurosurgical consultation', Journal of Trauma and Acute Care Surgery, vol. 75, no. 1, pp. 102-105. https://doi.org/10.1097/TA.0b013e3182946667
Joseph, Bellal ; Aziz, Hassan ; Sadoun, Moutamn ; Kulvatunyou, Narong ; Tang, Andrew ; OKeeffe, Terence ; Wynne, Julie ; Gries, Lynn ; Green, Donald J. ; Friese, Randall S. ; Rhee, Peter. / The acute care surgery model : Managing traumatic brain injury without an inpatient neurosurgical consultation. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 75, No. 1. pp. 102-105.
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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.",
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AU - Tang, Andrew

AU - OKeeffe, Terence

AU - Wynne, Julie

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