Tiffany L Overton1, Shahid Shafi2, George F Cravens3, Rajesh R Gandhi2. 1. Trauma Services, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA. Electronic address: toverton@jpshealth.org. 2. Department of Surgery, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA. 3. Department of Neurosurgery, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
Abstract
BACKGROUND: Current practices suggest that patients with mild traumatic brain injuries (MTBI) receive neurosurgical consultations, while less than 1% require neurosurgical intervention. We implemented a policy of selective neurosurgical consultation with the hypothesis that trauma surgeons alone may manage such patients with no impact on patient outcomes. METHODS: Data from a level I trauma registry were analyzed. Patients with MTBI resulting in an intracranial hemorrhage of 1 cm or less and a Glasgow Coma Score of 13 or greater were included. Patients with additional intracranial injuries were excluded. Multivariate regression was used to determine the relationship between neurosurgical management and good neurologic outcomes, while controlling for injury severity, demographics, and comorbidities. RESULTS: Implementation of the neurosurgical policy significantly reduced the number of such consults (94% before vs 65% after, P < .002). Multivariate analysis revealed that neurosurgical consultation was not associated with neurologic outcomes of patients. CONCLUSIONS: Implementation of a selective neurosurgical consultation policy for patients with MTBI reduced neurosurgical consultations without any impact on patient outcomes, suggesting that trauma surgeons can effectively manage these patients. Published by Elsevier Inc.
BACKGROUND: Current practices suggest that patients with mild traumatic brain injuries (MTBI) receive neurosurgical consultations, while less than 1% require neurosurgical intervention. We implemented a policy of selective neurosurgical consultation with the hypothesis that trauma surgeons alone may manage such patients with no impact on patient outcomes. METHODS: Data from a level I trauma registry were analyzed. Patients with MTBI resulting in an intracranial hemorrhage of 1 cm or less and a Glasgow Coma Score of 13 or greater were included. Patients with additional intracranial injuries were excluded. Multivariate regression was used to determine the relationship between neurosurgical management and good neurologic outcomes, while controlling for injury severity, demographics, and comorbidities. RESULTS: Implementation of the neurosurgical policy significantly reduced the number of such consults (94% before vs 65% after, P < .002). Multivariate analysis revealed that neurosurgical consultation was not associated with neurologic outcomes of patients. CONCLUSIONS: Implementation of a selective neurosurgical consultation policy for patients with MTBI reduced neurosurgical consultations without any impact on patient outcomes, suggesting that trauma surgeons can effectively manage these patients. Published by Elsevier Inc.
Authors: Carl Marincowitz; Fiona E Lecky; William Townend; Aditya Borakati; Andrea Fabbri; Trevor A Sheldon Journal: J Neurotrauma Date: 2018-01-11 Impact factor: 5.269
Authors: Stephen W Cooper; Kimberly B Bethea; Trevor J Skrobut; Rod Gerardo; Karen Herzing; Juan Torres-Reveron; Akpofure Peter Ekeh Journal: Trauma Surg Acute Care Open Date: 2019-11-17