title: Routine neurosurgical consultation is not necessary in mild blunt traumatic brain injury.
abstract: The Brain Trauma Foundation guidelines provide indications for neurosurgical intervention in traumatic brain injury (TBI) with moderate or severe intracranial hemorrhage (ICH). In TBI patients with less severe ICH, the utility of neurosurgical consultation remains unclear. We sought to determine if routine neurosurgical consultation is necessary for mild blunt TBI patients with ICH.
  
  
  
  A retrospective cohort study was conducted on 500 consecutive blunt TBI patients aged 15 years or older with Glasgow Coma Scale score of ≥13 and ICH on initial head computed tomography admitted to a Level I trauma center over 28 months. Outcomes were neurosurgical intervention (craniotomy, craniectomy, ventriculostomy, or intracranial pressure monitor placement) and in-hospital mortality. Statistical significance was assessed at a p < 0.05.
  
  
  
  Of 500 patients, 49 (9.8%) underwent neurosurgical intervention. Neurosurgical intervention was more frequent in male patients (75.5% vs. 61.2%, p = 0.049), patients with higher head Abbreviated Injury Scale score (4.7 vs. 3.8, p < 0.0001), patients with an abnormal initial neurological examination (30.6% vs. 12.6%, p = 0.001), or patients with skull fracture (28.6% vs. 16.0%, p = 0.026) and was associated with higher mortality (8.2% vs. 2.0%, p = 0.010). Neurosurgical intervention was not associated with intoxication, preinjury antiplatelet/anticoagulation agents, or progression of ICH on second head computed tomography. Neurosurgical consultation was documented in 466 patients (93.2%). For patients without neurosurgical intervention, consultation did not change management.
  
  
  
  Routine neurosurgical consultation for blunt TBI with ICH seems unnecessary, regardless of intoxication or preinjury antiplatelet or anticoagulation therapy. A more selective approach is warranted to decrease hospital charges and optimize use of neurosurgical consultation.
  
  
  
  Care management study, level IV.
authors.affiliation: From the Trauma Service, Scripps Mercy Hospital, San Diego, California.
authors.forename: Paul R
authors.initials: PR
authors.lastname: Lewis
authors.forename: Casey E
authors.initials: CE
authors.lastname: Dunne
authors.forename: James D
authors.initials: JD
authors.lastname: Wallace
authors.forename: Jason B
authors.initials: JB
authors.lastname: Brill
authors.forename: Richard Y
authors.initials: RY
authors.lastname: Calvo
authors.forename: Jayraan
authors.initials: J
authors.lastname: Badiee
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Sise
authors.forename: Vishal
authors.initials: V
authors.lastname: Bansal
authors.forename: C Beth
authors.initials: CB
authors.lastname: Sise
authors.forename: Steven R
authors.initials: SR
authors.lastname: Shackford
mesh_terms: D015998:Abbreviated Injury Scale; D000328:Adult; D000368:Aged; D001924:Brain Concussion / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D005260:Female; D015600:Glasgow Coma Scale; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*