K. Harris1, A. Brusnahan1, S. Shugar1, J. Miner1 1Wright State University, Department Of Surgery, Dayton, OH, USA
Introduction: There’s currently no universally agreed-upon definition for a mild traumatic brain injury (mTBI) and several national organizations have published differing definitions. We propose that the ideal definition of a mTBI would identify patients who do not require neurosurgical intervention, avoid unnecessary use of costly or invasive testing/interventions, and provide safe patient care. An under-triage rate of < 5% and an over-triage rate of < 35% are considered acceptable according to the American College of Surgeons Committee on Trauma (ACS-COT). Using the published definitions, we set out to determine which definition would best fit these criteria. Once the ideal definition was identified, one could perform prospective studies to validate the definition specifically looking at changes in patient morbidity and mortality, hospital length of stay, ICU admission, neurosurgical consults, and assess cost analysis.
Methods: A single-center, retrospective review of all adult patients with blunt TBI admitted to a Level 1 trauma center between August 2015 and December 2018 was performed to compare the clinical accuracy of the published definitions of mTBI. Patients were then classified by mTBI definition. Each cohort was then compared by rates of over- and under-triage based on ICU admission and the need for neurosurgical intervention.
Results: We identified 969 adult patients with blunt TBI and GCS 13-15 of which 597 were included in the final study. Overall mortality was 1.8%. 220 patients were on antiplatelets or anticoagulants, 275 (46%) underwent ICU admission, and 23 required neurosurgical intervention. All 597 patients met mTBI criteria according to the CDC and ACRM definitions. Of these, 459 had a positive head CT, and 220 patients were on antiplatelets or anticoagulants. 275 patients required ICU admission, and 23 underwent neurosurgical intervention. According to EAST and VA/DoD criteria, 129 patients met the criteria for mTBI. 22 were on antiplatelet or anticoagulant medication, 22 required ICU admission, and 0 underwent neurosurgical intervention. Lastly, 335 patients met BIG 1 and BIG 2 criteria. 210 patients had a positive head CT, 113 were admitted to the ICU, and 1 underwent neurosurgical intervention.
Conclusion: Of the published definitions for mTBI, the BIG criteria had the most ideal outcome. The BIG criteria limited over-triage while meeting ACS-COT goals for avoiding under-triage. Institutional adoption of the BIG criteria to guide the treatment of mTBI safely prioritizes care, appropriately informs diagnostic workup and clinical management, conserves healthcare resources, and limits costs to patients.
