To observe or not to observe: Evaluation of the modified brain injury guideline management of small volume intracranial hemorrhage

Janet S Lee; Joshua Billings; Robert C McIntyre; Valerie Brockman; Cassie Decker; Zachery Stillman; Jennifer Rodriquez; Elizabeth Graf; Stephanie Vega; John McVicker; Thomas J Schroeppel

doi:10.1016/j.amjsurg.2023.06.023

To observe or not to observe: Evaluation of the modified brain injury guideline management of small volume intracranial hemorrhage

Am J Surg. 2023 Dec;226(6):808-812. doi: 10.1016/j.amjsurg.2023.06.023. Epub 2023 Jun 28.

Authors

Affiliations

¹ Department of Trauma and Acute Care Surgery, UCHealth Memorial Hospital, Colorado Springs, CO, USA; Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA. Electronic address: [email protected].
² Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA. Electronic address: [email protected].
³ Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA. Electronic address: [email protected].
⁴ Department of Trauma Research, UCHealth Memorial Hospital, Colorado Springs, CO, USA. Electronic address: [email protected].
⁵ Department of Trauma Research, UCHealth Memorial Hospital, Colorado Springs, CO, USA. Electronic address: [email protected].
⁶ Department of Trauma Research, UCHealth Memorial Hospital, Colorado Springs, CO, USA. Electronic address: [email protected].
⁷ Department of Trauma Research, UCHealth Memorial Hospital, Colorado Springs, CO, USA. Electronic address: [email protected].
⁸ Department of Trauma Research, UCHealth Memorial Hospital, Colorado Springs, CO, USA. Electronic address: [email protected].
⁹ Department of Surgery, University of Colorado Anschutz Medical Center, Aurora, CO, USA. Electronic address: [email protected].
¹⁰ Department of Neurosurgery, UCHealth Memorial Hospital, Colorado Springs, CO, USA. Electronic address: [email protected].
¹¹ Department of Trauma and Acute Care Surgery, UCHealth Memorial Hospital, Colorado Springs, CO, USA. Electronic address: [email protected].

PMID: 37394349
DOI: 10.1016/j.amjsurg.2023.06.023

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.

Keywords: Modified brain injury guidelines; Observation period; Traumatic brain injury.

MeSH terms

Brain Injuries*
Emergency Service, Hospital
Glasgow Coma Scale
Hospitalization
Humans
Intracranial Hemorrhages / diagnostic imaging
Intracranial Hemorrhages / etiology
Intracranial Hemorrhages / surgery
Retrospective Studies