title: Identification of low-risk patients with traumatic brain injury and intracranial hemorrhage who do not need intensive care unit admission.
abstract: BACKGROUND
  Patients with traumatic brain injury (TBI) and traumatic intracranial hemorrhage are frequently admitted to the intensive care unit (ICU) but never require critical care interventions. Improved ICU triage in this patient population can improve resource utilization and decrease health care costs. We sought to identify a low-risk group of patients with TBI who do not require admission to an ICU.
  
  
  METHODS
  This is a retrospective cohort study of adult patients with TBI and traumatic intracranial hemorrhage. The need for ICU admission was defined as the presence of a critical care intervention. Patients were considered low risk if there was no critical care intervention before hospital admission. Measured outcomes included delayed critical care interventions at 48 hours and during hospitalization, mortality, and emergency surgery.
  
  
  RESULTS
  A total of 187 of 320 patients were considered low risk. In the low-risk group, two patients (1.1%; 95% confidence interval [CI], 0.1-3.8) had a delayed critical care intervention within 48 hours of admission and four patients (2.1%; 95% CI, 0.6-5.4) after 48 hours of admission. Two patients (1.1%; 95% CI, 0-3.8) in the low-risk group died. No patients in the low-risk group required neurosurgical intervention.
  
  
  CONCLUSIONS
  Patients with TBI without a critical care intervention before admission are at low risk for requiring future critical care interventions. Future studies are required to validate if this low-risk criteria can serve as a safe, cost-effective triage tool for ICU admission.
authors.affiliation: Department of Emergency Medicine, UC Davis School of Medicine, Sacramento, California 95817-2282, USA. daniel.nishijima@ucdmc.ucdavis.edu
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Nishijima
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Sena
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
mesh_terms: D001930:Brain Injuries / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D016009:Chi-Square Distribution; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D020300:Intracranial Hemorrhages / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices; D014218:Triage
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