Introduction: Practice paradigms for mild traumatic brain injury (mTBI) include hospital admission and serial radiologic evaluation. Deciphering the extent to which patients need evaluation and monitoring remains a challenge. We review our institutional experience on management of mTBI to identify predictors of need for hospital admission.
Methods: Patients presenting to a level 1 trauma center with a mTBI (GCS13-15) between February 2013- June2014 were retrospectively reviewed. Basic demographics, hospital course metrics, and need for neurosurgical intervention were obtained. Statistical analysis was performed using c2 test, Mann-Whitney U, and Kruskal-Wallis tests. Multivariate logistic regression analysis was performed to identify independent predictors of outcomes. Demographic data are listed in Table 1.
Results: Patients with GCS 15 were less likely to undergo repeat imaging compared with those with GCS 13 or 14. Patients with GCS of 13 or 14 were significantly more likely to be admitted to the ICU (p = 0.039), whereas those with GCS of 15 were more likely to be admitted to the floor (p = 0.05). Patients with GCS 13 were more likely to have SAH (p = 0.025), EDH (p = 0.001), and skull fracture (p = 0.026). Patients with IPH, SDH, or skull fracture were more likely to be admitted than those with SAH or EDH. Patients with SDH or skull fracture were more likely to have neurological decline than those with SAH, IPH, or EDH.
Conclusions: GCS and the presence of ICH or skull fracture are the main factors determining need for hospitalization. These results can be used to determine patients appropriate for discharge rather than admission. Making this distinction may decrease the financial burden of TBI and help to improve allotment of resources to these patients. This pilot project is for quality improvement to maintain safety and increase efficiency, and decrease health care costs.
Patient Care: It will improve the safety, quality, and efficiency as well as reduce the cost associated with the management and care of patients with mild traumatic brain injury.
Learning Objectives: By the conclusion of this session, participants should be able to identify the characteristics of patients with mild TBI that make patients more susceptible to deterioration.