T. J. Herron1, D. M. Davis1, L. Rabach1, Z. Boucher1, D. Ciesla1 1University Of South Florida College Of Medicine,Trauma & Acute Care Surgery/Surgery,Tampa, FL, USA
Introduction: There are guidelines for the use of computed tomography (CT) in the evaluation of patients with Mild Traumatic Brain Injury (TBI), defined as a Glasgow Coma Scale (GCS) of 13-15. Our clinical observation suggests the use of immediate head CT in patients with mild TBI infrequently leads to operative intervention or invasive intracranial pressure monitoring.
Methods: Trauma patients with an initial Glasgow Coma Scale of 13-15 who presented to a level 1 trauma center were retrospectively reviewed from a prospective database over a 3-year period. All patients underwent an initial head CT scan as part of their trauma work up and had subsequent admission to the hospital. Patients on antiplatelet agents or anticoagulation, or with known intracranial pathology were excluded.
Results: A total of 326 patients were reviewed. Of this, 115 patients met exclusion criteria, for a sample size of 211 patients. Four patients (1.89%) required operative intervention; one presented with a GCS 15, one with GCS 14. These patients underwent operative intervention only after having a decline in their GCS while under observation. Two patients who presented with a GCS of 13 underwent operation based on initial CT findings. Two patients (0.9%) underwent invasive cranial monitoring. In both cases, ICP monitoring was initiated after a decline in GCS while under observation. There was one mortality in the study; there were no mortalities in the patients that underwent intervention. Overall, 97% of patients were observed without need for operative intervention or ICP monitoring.
Conclusion: In trauma patients presenting with GCS of 14 or 15, intervention was only necessary if there was a decline in clinical neurologic examination. Trauma Patients with a GCS of 14 or 15 and an indication for hospital admission can be observed for a decline in neurologic status without the need for initial or serial head CTs.