title: Can trauma surgeons manage mild traumatic brain injuries?
abstract: BACKGROUND
  Current practices suggest that patients with mild traumatic brain injuries (MTBI) receive neurosurgical consultations, while less than 1% require neurosurgical intervention. We implemented a policy of selective neurosurgical consultation with the hypothesis that trauma surgeons alone may manage such patients with no impact on patient outcomes.
  
  
  METHODS
  Data from a level I trauma registry were analyzed. Patients with MTBI resulting in an intracranial hemorrhage of 1 cm or less and a Glasgow Coma Score of 13 or greater were included. Patients with additional intracranial injuries were excluded. Multivariate regression was used to determine the relationship between neurosurgical management and good neurologic outcomes, while controlling for injury severity, demographics, and comorbidities.
  
  
  RESULTS
  Implementation of the neurosurgical policy significantly reduced the number of such consults (94% before vs 65% after, P < .002). Multivariate analysis revealed that neurosurgical consultation was not associated with neurologic outcomes of patients.
  
  
  CONCLUSIONS
  Implementation of a selective neurosurgical consultation policy for patients with MTBI reduced neurosurgical consultations without any impact on patient outcomes, suggesting that trauma surgeons can effectively manage these patients.
authors.affiliation: Trauma Services, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA. Electronic address: toverton@jpshealth.org.
authors.forename: Tiffany L
authors.initials: TL
authors.lastname: Overton
authors.affiliation: Department of Surgery, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
authors.forename: Shahid
authors.initials: S
authors.lastname: Shafi
authors.affiliation: Department of Neurosurgery, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
authors.forename: George F
authors.initials: GF
authors.lastname: Cravens
authors.affiliation: Department of Surgery, JPS Health Network, 1500 S. Main St., Fort Worth, TX 76104, USA.
authors.forename: Rajesh R
authors.initials: RR
authors.lastname: Gandhi
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000175:diagnosis / Q000628:therapy*; D002985:Clinical Protocols; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009493:Neurosurgery; D012017:Referral and Consultation / Q000592:standards*; D012189:Retrospective Studies; D014193:Trauma Centers / Q000592:standards*; D014194:Traumatology; D016896:Treatment Outcome
keywords: Mild TBI management; Mild traumatic brain injury; Neurosurgeon consultation; Neurosurgical management; Policy implementation