Lee JS, Billings J, McIntyre RC, Brockman V, Decker C, Stillman Z, Rodriquez J, Graf E, Vega S, McVicker J, Schroeppel TJ. To observe or not to observe: Evaluation of the modified brain injury guideline management of small volume intracranial hemorrhage.
Am J Surg 2023;
226:808-812. [PMID:
37394349 DOI:
10.1016/j.amjsurg.2023.06.023]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/03/2023] [Accepted: 06/20/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION
Patients with small volume intracranial hemorrhage (ICH) are categorized as modified Brain Injury Guidelines (mBIG) 1 and are managed with a 6-h emergency department (ED) observation period. The current study aimed to describe the mBIG 1 patient population and determine the utility of the ED observation period.
METHODS
A retrospective analysis was performed on trauma patients with small volume ICH. Exclusion criteria were Glasgow Coma Scale (GCS) < 13 and penetrating injuries.
RESULTS
359 patients were identified over the 8-year study period. The most common ICH was SDH (52.7%) followed by SAH (50.1%). Two patients (0.56%) had neurologic deterioration, but neither had radiographic progression. Overall, 14.3% of the cohort had radiographic progression; none required neurosurgical intervention. Four patients (1.1%) had readmission related to TBI from the index admission.
CONCLUSION
There were no patients with small volume ICH that required neurosurgical intervention despite a small subset of patients having radiographic or clinical deterioration. Patients who meet the mBIG 1 criteria may be managed safely without an ED observation period.
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