Necessity of In-hospital Neurological Observation for Mild Traumatic Brain Injury Patients with Negative Computed Tomography Brain Scans

Abstract

Objective: The authors aimed to evaluate the necessity of in-hospital neurological observation for mild traumatic brain injury (TBI) patients, who did not have any evidence of intracranial injury from initial computed tomography (CT) brain scans. Material and Methods: We retrospectively reviewed mild TBI patients with initial negative CT brain scans, receiving treatment at Songklanagarind hospital between January and December, 2018. All patients were observed in the emergency department short stay observation unit for 24 hours after injury. Patients’ medical records, initial and official CT brain scan interpretation were collected and analyzed. Results: This study included 493 cases. No patient deteriorated from intracranial injury, while one patient deteriorated from hypoglycemia, associated with his underlying adrenal insufficiency. However, one patient was admitted to the in patient ward, due to a missed diagnosis of acute subdural hematoma from his initial CT interpretation. The incidence of missed intracranial injury from initial CT brain scan interpretation was 1.6%. The need for neurosurgical intervention (in-patient ward admission, anticonvulsant and repeat brain imaging) was 0.2% (1/493). No patient required surgical intervention.Conclusion: Mild TBI patients, with initial negative CT brain scans, have very low risk for deterioration or need of neurosurgical intervention. Patient's underlying major comorbidity may be considered as an indication for in-hospital observation.

Comparison of intracranial injury predictability between machine learning algorithms and the nomogram in pediatric traumatic brain injury

“…8 Nomograms built from a model of logistic or Cox regression have been used in neurosurgery as diagnostic or prediction tools. [9][10][11] Tunthanatip et al developed a nomogram for predicting positive findings following CT of the brain in pediatric patients with TBI and reported an area under the receiver operating characteristic (ROC) curve (AUC) of 0.71. 11 After conducting a literature review, we found a lack of evidence comparing predictive performance between ML and the nomogram with the same clinical outcome.…”

Development of a nomogram to predict the outcome of moderate or severe pediatric traumatic brain injury

“…However, a low prevalence of moderate or severe pediatric TBI was observed in previous studies as 7.5%–29.8% for moderate TBI and 7.9%–13% for severe TBI, respectively. [ 3 4 5 25 ] A multicenter study or meta-analysis studies were previously conducted in an attempt to resolve this limitation, while the propensity score approach was also adopted to adjust the selection bias and non-randomized study design. [ 26 ]…”

Prognostic Impact of the Combination of MGMT Methylation and TERT Promoter Mutation in Glioblastoma

“…Therefore, selecting GBM patients by predicted favorable prognosis has been proposed for the likelihood of TMZ cost-effectiveness in real-world situations. 24 Nomogram is one of the clinical prediction tools (CPT) that have been used for various diseases such as cancer, 25 trauma, 26,27 or degenerative disease. 28 Therefore, we proposed a web-based nomogram for prognostication that will be applied for selecting patients with a favorable prognosis when low-or middle-income settings need to allocate resources.…”