Can trauma surgeons manage mild traumatic brain injuries?

Overton, Tiffany L.; Shafi, Shahid; Cravens, George; Gandhi, Rajesh R.

doi:10.1016/j.amjsurg.2014.02.012

Cited by 12 publications

(17 citation statements)

References 10 publications

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“… 63 , 87 , 98 , 108 Forty-six studies estimated the outcomes of interest and contributed to pooled estimates of risk. 6–9 , 27 , 28 , 30 , 32 , 37 , 41 , 42 , 52 , 54 , 55 , 57 , 59 , 60 , 62 , 63 , 65 , 66 , 69 , 71 , 73–78 , 86 , 87 , 90 , 93 , 97–104 , 106–109 , 114 , 125 , 130 , 139 Four studies presented data regarding specific injury subtypes. 32 , 55 , 71 , 103 One study only contributed to the narrative synthesis due to the outcome measure it assessed.…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-one studies presented either uni-variate or multi-variable analysis assessing prognostic factors' effect on the outcomes of interest. 6 , 37 , 41 , 54 , 55 , 66 , 69 , 71 , 73–78 , 87 , 98–101 , 130 , 139 Sixteen studies presented multi-variable models using logistic regression or recursive partitioning. 6 , 37 , 41 , 54 , 55 , 66 , 69 , 71 , 73 , 74 , 77 , 78 , 98 , 100 , 101 , 130 Only two studies attempted to validate such models by splitting the study datasets.…”

Section: Resultsmentioning

confidence: 99%

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The Risk of Deterioration in GCS13–15 Patients with Traumatic Brain Injury Identified by Computed Tomography Imaging: A Systematic Review and Meta-Analysis

Marincowitz

Lecky

Townend

et al. 2018

Journal of Neurotrauma

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The optimal management of mild traumatic brain injury (TBI) patients with injuries identified by computed tomography (CT) brain scan is unclear. Some guidelines recommend hospital admission for an observation period of at least 24 h. Others argue that selected lower-risk patients can be discharged from the Emergency Department (ED). The objective of our review and meta-analysis was to estimate the risk of death, neurosurgical intervention, and clinical deterioration in mild TBI patients with injuries identified by CT brain scan, and assess which patient factors affect the risk of these outcomes. A systematic review and meta-analysis adhering to PRISMA standards of protocol and reporting were conducted. Study selection was performed by two independent reviewers. Meta-analysis using a random effects model was undertaken to estimate pooled risks for: clinical deterioration, neurosurgical intervention, and death. Meta-regression was used to explore between-study variation in outcome estimates using study population characteristics. Forty-nine primary studies and five reviews were identified that met the inclusion criteria. The estimated pooled risk for the outcomes of interest were: clinical deterioration 11.7% (95% confidence interval [CI]: 11.7%–15.8%), neurosurgical intervention 3.5% (95% CI: 2.2%–4.9%), and death 1.4% (95% CI: 0.8%–2.2%). Twenty-one studies presented within-study estimates of the effect of patient factors. Meta-regression of study characteristics and pooling of within-study estimates of risk factor effect found the following factors significantly affected the risk for adverse outcomes: age, initial Glasgow Coma Scale (GCS), type of injury, and anti-coagulation. The generalizability of many studies was limited due to population selection. Mild TBI patients with injuries identified by CT brain scan have a small but clinically important risk for serious adverse outcomes. This review has identified several prognostic factors; research is needed to derive and validate a usable clinical decision rule so that low-risk patients can be safely discharged from the ED.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

The Risk of Deterioration in GCS13–15 Patients with Traumatic Brain Injury Identified by Computed Tomography Imaging: A Systematic Review and Meta-Analysis

Marincowitz

Lecky

Townend

et al. 2018

Journal of Neurotrauma

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“…A more selective approach has been proposed, with repeat studies in patients with deterioration in their Glasgow Coma Score (GCS) 4 5. The need for a mandatory neurosurgery consultation has also been questioned 6 7…”

Section: Introductionmentioning

confidence: 99%

Management of traumatic subarachnoid hemorrhage by the trauma service: is repeat CT scanning and routine neurosurgical consultation necessary?

Cooper

Bethea

Skrobut

et al. 2019

Trauma Surg Acute Care Open

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Subarachnoid hemorrhage (SAH) results frequently from traumatic brain injury (TBI). The standard management for these patients includes brief admission by the acute care surgery (trauma) service with neurological checks, neurosurgical consultation and repeat head CT within 24 hours to identify any progression or resolution. Recent studies have questioned the need for repeat CT imaging and specialty consultation in mild TBI. We reviewed patients with mild TBI specifically with isolated SAH to determine progression of the pathology and need for neurosurgical involvement. All patients with SAH secondary to mild TBI (Glasgow Coma Score (GCS) of 13–15) who presented over a 5-year period (January 2010 to December 2014) to a level I trauma center were identified from the trauma registry. Demographic data, initial CT findings, neurosurgical consultation, follow-up CT findings, Injury Severity Score (ISS), admission GCS and length of stay (LOS) were all obtained from the patient’s charts. Patients with other traumatic brain lesions on the initial CT were excluded. There were 299 patients (male, 48.5%), mean age 60.9 and mean ISS 8. Average time between the first and second CT was 11.3 hours. In all, 267 (89.2%) patients had either no change or an improvement/resolution on follow-up CT scan. Only 26 patients (8.7%) had either worsening or new findings on CT. Eight patients did not have a second scan completed (2.6%). All patients had neurosurgical consultation. Patients with mild TBI with isolated SAH generally have low morbidity, short LOS and negligible mortality. Less than 10% of this population had worsening of their head injury on repeat CT scanning. Given the low acuity of these patients with SAH and tendency towards resolution without intervention, acute care surgeons can manage this specific group of patients with TBI without routine neurosurgical consultation. Repeat CT scanning continues to have utility as it may identify new lesions, deterioration or need for further management.

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“…Although physiotherapy plays an important role in TBI, but is unable to cure coma patients and prognostic potential for this therapy is still insufficient. Surgical treatment is another option to treat TBI, but is limited to treat mild TBI [32]. Mild hypothermia is also used for the treatment of brain and SCI, but this therapy has numerous pitfalls such as pathological and physiological changes as well as potential side effects are observed during this treatment [33].…”

Section: Discussionmentioning

confidence: 99%

Human Embryonic Stem Cells in the Treatment of Patients with Traumatic Brain Injury

Shroff¹

2015

SOJN

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Can trauma surgeons manage mild traumatic brain injuries?

Cited by 12 publications

References 10 publications

The Risk of Deterioration in GCS13–15 Patients with Traumatic Brain Injury Identified by Computed Tomography Imaging: A Systematic Review and Meta-Analysis

The Risk of Deterioration in GCS13–15 Patients with Traumatic Brain Injury Identified by Computed Tomography Imaging: A Systematic Review and Meta-Analysis

Management of traumatic subarachnoid hemorrhage by the trauma service: is repeat CT scanning and routine neurosurgical consultation necessary?

Human Embryonic Stem Cells in the Treatment of Patients with Traumatic Brain Injury

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