title: Prospective validation of the brain injury guidelines: managing traumatic brain injury without neurosurgical consultation.
abstract: BACKGROUND
  To optimize neurosurgical resources, guidelines were developed at our institution, allowing the acute care surgeons to independently manage traumatic intracranial hemorrhage less than or equal to 4 mm. The aim of our study was to evaluate our established Brain Injury Guidelines (BIG 1 category) for managing patients with traumatic brain injury (TBI) without neurosurgical consultation.
  
  
  METHODS
  We formulated the BIG based on a 4-year retrospective chart review of all TBI patients presenting at our Level 1 trauma center. We then prospectively implemented our BIG 1 category to identify TBI patients that were to be managed without neurosurgical consultation (No-NC). Propensity scoring matched patients with No-NC to a similar cohort of patients managed with NC before the implementation of our BIG in a 1:1 ratio for demographics, severity of injury, and type and size of intracranial hemorrhage. Primary outcome measure was need for neurosurgical intervention and 30-day readmission rates.
  
  
  RESULTS
  A total of 254 TBI patients (127 of NC and 127 of No-NC patients) were included in the analysis. The mean (SD) age was 40.8 (22.7) years, 63.4% (n = 161) were male, median Glasgow Coma Scale (GCS) score was 15 (range, 13-15), and median head Abbreviated Injury Scale (AIS) score was 2 (range, 2-3). There was no neurosurgical intervention or 30-day readmission in both the groups. In the No-NC group, 3.9% of the patients had postdischarge emergency department visits compared with 4.7% of the NC group (p = 0.5). All patients were discharged home from the emergency department.
  
  
  CONCLUSIONS
  We validated our BIG and demonstrated that acute care surgeons can effectively care for minimally injured TBI patients with good outcomes. A national multi-institutional prospective evaluation is warranted.
  
  
  METHODS
  Therapeutic/care management, level IV.
authors.affiliation: From the Division of Trauma, Emergency Surgery, Critical Care, and Burns; Department of Surgery, University of Arizona Medical Center, Tucson, Arizona.
authors.forename: Bellal
authors.initials: B
authors.lastname: Joseph
authors.forename: Hassan
authors.initials: H
authors.lastname: Aziz
authors.forename: Viraj
authors.initials: V
authors.lastname: Pandit
authors.forename: Narong
authors.initials: N
authors.lastname: Kulvatunyou
authors.forename: Moutamn
authors.initials: M
authors.lastname: Sadoun
authors.forename: Andrew
authors.initials: A
authors.lastname: Tang
authors.forename: Terence
authors.initials: T
authors.lastname: O'Keeffe
authors.forename: Lynn
authors.initials: L
authors.lastname: Gries
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Green
authors.forename: Randall S
authors.initials: RS
authors.lastname: Friese
authors.forename: Michael G
authors.initials: MG
authors.lastname: Lemole
authors.forename: Peter
authors.initials: P
authors.lastname: Rhee
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D020300:Intracranial Hemorrhages / Q000175:diagnosis* / Q000601:surgery / Q000628:therapy; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D017410:Practice Guidelines as Topic / Q000592:standards; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed