Minimal-risk traumatic brain injury management without neurosurgical consultation

Background Traumatic brain injury (TBI) with intracranial hemorrhage management results in clinical practice variability, complexity, and/or limitations in acute care surgical and radiological workflow, which can prompt neurosurgical consultation, even when unnecessary. To facilitate an interdisciplinary practice for minimal-risk TBI, our objective was to create and sustain a neurotrauma protocol change that we hypothesized would not result in outcome differences. Methods A retrospective pre-post cohort study was conducted over an 8-month period to evaluate the protocol change toward trauma team management of TBI with isolated pneumocephalus and/or subarachnoid hemorrhage (SAH) given a normal neurologic exam (i.e., minimal-risk TBI) without neurosurgery consultation. Demographics of age and Glasgow coma scale (GCS) were collected and expressed in means. Target outcomes consisted of protocol compliance, management compliance (e.g., nursing neurologic checks, thromboembolism prophylaxis, seizure prophylaxis, speech-cognitive testing, follow-up), neurological worsening, increasing therapeutic intensity levels, and TBI-related 30-day readmission. Results Of the 49 patients included, 21 were in the pre-group (age, 54.19 years; GCS, 15) and 28 were in the post-group (age, 52.25 years; GCS, 15). There was 5% and 36% non-compliance with pre- and post-protocol practices in terms of neurosurgery consultation rates. In both pre- and post-periods, management compliance was similar, and none of the TBI patients experienced a worsening neurologic exam, increased therapeutic intensity level, or re-admission. Conclusion Minimal TBI-risk protocol compliance was weaker after the practice change although management compliance and outcomes remained unchanged. This work supports that minimal-risk TBI patients with SAH and normal neurologic exams can be safely managed by trauma teams without neurosurgery consultation.

Abstract licence: CC BY-NC

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