title: ED disposition of the Glasgow Coma Scale 13 to 15 traumatic brain injury patient: analysis of the Transforming Research and Clinical Knowledge in TBI study.
abstract: OBJECTIVE
  Mild traumatic brain injury (mTBI) patients are frequently admitted to high levels of care despite limited evidence suggesting benefit. Such decisions may contribute to the significant cost of caring for mTBI patients. Understanding the factors that drive disposition decision making and how disposition is associated with outcomes is necessary for developing an evidence-base supporting disposition decisions. We evaluated factors associated with emergency department triage of mTBI patients to 1 of 3 levels of care: home, inpatient floor, or intensive care unit (ICU).
  
  
  METHODS
  This multicenter, prospective, cohort study included patients with isolated head trauma, a cranial computed tomography as part of routine care, and a Glasgow Coma Scale (GCS) score of 13 to 15. Data analysis was performed using multinomial logistic regression.
  
  
  RESULTS
  Of the 304 patients included, 167 (55%) were discharged home, 76 (25%) were admitted to the inpatient floor, and 61 (20%) were admitted to the ICU. In the multivariable model, admission to the ICU, compared with floor admission, varied by study site, odds ratio (OR) 0.18 (95% confidence interval [CI], 0.06-0.57); antiplatelet/anticoagulation therapy, OR 7.46 (95% CI, 1.79-31.13); skull fracture, OR 7.60 (95% CI, 2.44-23.73); and lower GCS, OR 2.36 (95% CI, 1.05-5.30). No difference in outcome was observed between the 3 levels of care.
  
  
  CONCLUSIONS
  Clinical characteristics and local practice patterns contribute to mTBI disposition decisions. Level of care was not associated with outcomes. Intracranial hemorrhage, GCS 13 to 14, skull fracture, and current antiplatelet/anticoagulant therapy influenced disposition decisions.
authors.affiliation: Emergency Medicine and Neurocritical Care, University of Cincinnati, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267-0769. Electronic address: ratclijn@uc.edu.
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Ratcliff
authors.affiliation: Emergency Medicine and Neurosurgery, University of Cincinnati, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267-0769. Electronic address: adeoyeo@uc.edu.
authors.forename: Opeolu
authors.initials: O
authors.lastname: Adeoye
authors.affiliation: Emergency Medicine, University of Cincinnati, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267-0769. Electronic address: lindsecj@ucmail.uc.edu.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lindsell
authors.affiliation: Emergency Medicine, University of Cincinnati, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267-0769. Electronic address: hartkb@ucmail.uc.edu.
authors.forename: Kimberly W
authors.initials: KW
authors.lastname: Hart
authors.affiliation: Emergency Medicine, University of Cincinnati, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267-0769. Electronic address: arthur.pancioli@uc.edu.
authors.forename: Arthur
authors.initials: A
authors.lastname: Pancioli
authors.affiliation: Emergency Medicine, University of Cincinnati, 231 Albert Sabin Way, PO Box 670769, Cincinnati, OH 45267-0769. Electronic address: jason.mcmullan@uc.edu.
authors.forename: Jason T
authors.initials: JT
authors.lastname: McMullan
authors.affiliation: Neurological Surgery, University of California, San Francisco, 1001 Potrero Ave, Building 1 Room 101, San Francisco, CA 94110. Electronic address: yuej@neurosurg.ucsf.edu.
authors.forename: John K
authors.initials: JK
authors.lastname: Yue
authors.affiliation: Emergency Medicine, University of California, Davis, 4150 V St, Suite 2100, Sacramento, CA 95817. Electronic address: daniel.nishijima@ucdmc.ucdavis.edu.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Nishijima
authors.affiliation: Rehabilitation Medicine, Mount Sinai School of Medicine, 1425 Madison Ave, Box 1240, New York, NY 10029. Electronic address: wayne.gordon@mssm.edu.
authors.forename: Wayne A
authors.initials: WA
authors.lastname: Gordon
authors.affiliation: Seton Brain and Spine Institute, 1400 North IH 35, Suite 300, Austin, TX. Electronic address: avaladka@gmail.com.
authors.forename: Alex B
authors.initials: AB
authors.lastname: Valadka
authors.affiliation: Neurological Surgery, University of Pittsburgh Medical Center, 200 Lothrop St Suite B-400, Pittsburgh, PA 15213. Electronic address: okonkwodo@upmc.edu.
authors.forename: David O
authors.initials: DO
authors.lastname: Okonkwo
authors.affiliation: Erasmus MC, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. Electronic address: h.lingsma@erasmusmc.nl.
authors.forename: Hester F
authors.initials: HF
authors.lastname: Lingsma
authors.affiliation: Neurosurgery, Antwerp University Hospital, University of Antwerp, Wilrijkstraat, Edegem, Belgium 102650. Electronic address: andrew.maas@uza.be.
authors.forename: Andrew I R
authors.initials: AI
authors.lastname: Maas
authors.affiliation: Emergency Medicine, University of California, Davis, 4150 V St, Suite 2100, Sacramento, CA 95817. Electronic address: manleyg@neurosurg.ucsf.edu.
authors.forename: Geoffrey T
authors.initials: GT
authors.lastname: Manley
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D001930:Brain Injuries / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D015600:Glasgow Coma Scale / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D020198:Intracranial Hemorrhage, Traumatic / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000628:therapy; D016015:Logistic Models; D008297:Male; D059906:Neuroimaging; D009483:Neuropsychological Tests; D063868:Patient Outcome Assessment; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D014218:Triage / Q000706:statistics & numerical data
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors