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 O'Keeffe, Lynn Gries, Donald J. Green, Randall S. Friese, Gerald M Lemole, Peter M Rhee

Research output: Contribution to journalArticlepeer-review

44 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


  • 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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