J. L. Pringle1, A. L. Bourgon1, M. A. Chaudhary1, F. Speranza1, S. Tisherman1, A. P. Ekeh1 1Wright State University,Surgery,Dayton, OH, USA
Introduction:
Mild TBI (MTBI) accounts for 80-90% of all TBI admissions and of all TBIs seen in the ED, 46% are associated with an intracranial hemorrhage. Up to 63% of MTBI are admitted to the intensive care unit (ICU) even though the majority of these patients do not require critical care interventions. We hypothesize that patients with a mild TBI and isolated intracranial hemorrhage do not require critical care interventions that necessitate an admission to the intensive care unit, and instead can be monitored on an advanced care floor.
Methods:
We conducted a retrospective cohort study of the Trauma Registry of an American College of Surgeons (ACS) verified Level 1 Trauma Center from February 2013 to March 2015. Patients with a MTBI, defined as a Glasgow Coma Scale (GCS) of 13-15, were included in the study. Primary outcome was patients requiring critical care interventions during admission. Critical care interventions were defined as mechanical ventilation, neurosurgical or neurointerventional procedures, vasopressor or inotropic use, transfusion of blood products, invasive monitoring and use of hypertonic saline solution.
Results:
A total of 250 patients were admitted to the ICU. 141 (56%) of these patients underwent a critical care intervention, 68 (48%) transfusions, 35 (25%) neurological intervention, 27 (19%) mechanical ventilation, 11(8%) hypertonic saline. 28 (41%) of the transfusions were platelets alone for clopidogrel and/or aspirin use or elevated platelet function tests. The average ISS for patients admitted to the ICU was 16.2. For those patients that were admitted to the ICU for ≤1 day, the average ISS was 13.9. Daily cost of ICU admission was $618 versus $297/day for admission to the advanced care units.
Conclusion:
In conclusion, 44% of the patients with MTBI and ICH that were admitted to the ICU did not require a critical care intervention. A majority of those that did require intervention only required transfusion of blood product. Based on this data, some patients with MTBI and ICH may be able to be monitored in an advanced care unit where nursing staff is adequate enough to be able to do frequent neurological checks. Evaluation of the patients ISS and intervention may give physicians a better ability to decide what level of care these patients need for improved utilization of medical resources.