title: Neurosurgical intervention in patients with mild traumatic brain injury and its effect on neurological outcomes.
abstract: OBJECTIVE
  The object of this study was to determine the mortality and neurological outcome of patients with mild traumatic brain injury (mTBI) who require neurosurgical intervention (NSI), identify clinical predictors of a poor outcome, and investigate the effect of failed nonoperative management and delayed NSI on outcome.
  
  
  METHODS
  A cross-sectional study of 10 years was performed, capturing all adults with mTBI and NSI. Primary outcome variables were mortality and Glasgow Outcome Scale (GOS) score. Patients were divided into an immediate intervention group, which received an NSI after the initial cranial CT scan, and a delayed intervention group, which had failed nonoperative management and received an NSI after 2 or more cranial CT scans.
  
  
  RESULTS
  The mortality rate in mTBI patients requiring NSI was 13%, and the mean GOS score was 3.6 ± 1.2. An age > 60 years was independently predictive of a worse outcome, and epidural hematoma was independently predictive of a good outcome. Logistic regression analysis using independent variables was calculated to create a model for predicting poor neurological outcomes in patients with mTBI undergoing NSI and had 74.1% accuracy. Patients in the delayed intervention group had worse mortality (25% vs 9%) and worse mean GOS scores (2.9 ± 1.3 vs 3.7 ± 1.2) than those in the immediate intervention group.
  
  
  CONCLUSIONS
  Data in this study demonstrate that patients with mTBI requiring NSI have higher mortality rates and worse neurological outcomes and should therefore be classified separately from mTBI patients not requiring NSI. Additionally, mTBI patients requiring NSI after the failure of nonoperative management have worse outcomes than those receiving immediate intervention and should be considered separately.
authors.affiliation: Departments of 1 Emergency Medicine.
authors.forename: Kevin James
authors.initials: KJ
authors.lastname: Tierney
authors.affiliation: Surgery, and.|Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, New York, New York.
authors.forename: Natasha V
authors.initials: NV
authors.lastname: Nayak
authors.affiliation: Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey; and.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Prestigiacomo
authors.affiliation: Surgery, and.
authors.forename: Ziad C
authors.initials: ZC
authors.lastname: Sifri
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D001930:Brain Injuries / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D003399:Craniotomy; D003430:Cross-Sectional Studies; D005260:Female; D015600:Glasgow Coma Scale; D006407:Hematoma, Epidural, Cranial / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology* / Q000473:pathology; D019635:Neurosurgical Procedures / Q000379:methods*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: AIS = Abbreviated Injury Score; GCS = Glasgow Coma Scale; GOS = Glasgow Outcome Scale; Glasgow Outcome Scale; ICB = intracranial bleed; ISS = Injury Severity Score; LOS = length of stay; NSI = neurosurgical intervention; elderly; mTBI = mild traumatic brain injury; mild traumatic brain injury; mortality