title: Should the management of isolated traumatic subarachnoid hemorrhage differ from concussion in the setting of mild traumatic brain injury?
abstract: BACKGROUND
  In the setting of mild traumatic brain injury (TBI), the clinical significance of a traumatic subarachnoid hemorrhage (tSAH) has not been sufficiently studied. We examined the impact of an isolated tSAH on patient outcomes in the mild TBI population.
  
  
  METHODS
  We retrospectively identified all mild TBI patients (Glasgow Coma Scale score ≥13) who presented to a Level I trauma center over a 10-year period. We compared isolated tSAH patients with isolated concussion patients. χ(2) and logistic regression analyses were used to compare intensive care unit (ICU) admission, ICU length of stay (LOS), hospital LOS, progression of tSAH, in-hospital mortality, and disposition to rehabilitation.
  
  
  RESULTS
  There were 1,144 concussion and 117 tSAH patients included in our study. After adjustment, tSAH patients had increased odds of admission to the ICU (odds ratio, [OR] = 8.87; p < 0.0001), yet their ICU LOS was significantly shorter (OR = 0.29; p = 0.01). The overall hospital LOS and mortality rate were not significantly different between the TBI groups. When stratified by age, only the 40-year to 69-year-old tSAH patients had significantly increased adjusted odds of disposition to rehabilitation compared with concussion patients, independent of ICU admission (OR = 7.96; p = 0.004). None of the patients required any neurosurgical interventions.
  
  
  CONCLUSIONS
  We encourage healthcare facilities to consider revising or creating ICU admission criteria for the mild TBI population to help optimize the utilization of their ICUs. We believe clinicians should place more emphasis on variables such as age, comorbidities, and neurologic condition rather than the presence of a small volume of blood in the subarachnoid space when admitting mild isolated TBI patients to the ICU.
authors.affiliation: InterMountain Neurosurgery, St. Anthony Central Hospital, Denver, Colorado, USA.
authors.forename: A Stewart
authors.initials: AS
authors.lastname: Levy
authors.forename: Alessandro
authors.initials: A
authors.lastname: Orlando
authors.forename: Allison P
authors.initials: AP
authors.lastname: Hawkes
authors.forename: Kristin
authors.initials: K
authors.lastname: Salottolo
authors.forename: Charles W
authors.initials: CW
authors.lastname: Mains
authors.forename: David
authors.initials: D
authors.lastname: Bar-Or
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001924:Brain Concussion / Q000401:mortality / Q000628:therapy*; D001930:Brain Injuries / Q000401:mortality / Q000628:therapy*; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020206:Subarachnoid Hemorrhage, Traumatic / Q000401:mortality / Q000628:therapy*