Minimal-risk traumatic brain injury management without neurosurgical consultation
Background Traumatic brain injury (TBI) with intracranial hemorrhage management results in clinical practice variability, complexity, and/or limitations in acute care surgical and radiological workflow, which can prompt neurosurgical consultation, even when unnecessary. To facilitate an interdiscipl...
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| Format: | Article |
| Language: | English |
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The Korean Neurocritical Care Society
2020-12-01
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| Series: | Journal of Neurocritical Care |
| Subjects: | |
| Online Access: | http://e-jnc.org/upload/pdf/jnc-200011.pdf |
| _version_ | 1811219030636232704 |
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| author | Elizabeth Starbuck Compton Benjamin Allan Smallheer Nicholas Russell Thomason Michael S. Norris Mina Faye Nordness Melissa D. Smith Mayur Bipin Patel |
| author_facet | Elizabeth Starbuck Compton Benjamin Allan Smallheer Nicholas Russell Thomason Michael S. Norris Mina Faye Nordness Melissa D. Smith Mayur Bipin Patel |
| author_sort | Elizabeth Starbuck Compton |
| collection | DOAJ |
| description | Background Traumatic brain injury (TBI) with intracranial hemorrhage management results in clinical practice variability, complexity, and/or limitations in acute care surgical and radiological workflow, which can prompt neurosurgical consultation, even when unnecessary. To facilitate an interdisciplinary practice for minimal-risk TBI, our objective was to create and sustain a neurotrauma protocol change that we hypothesized would not result in outcome differences. Methods A retrospective pre-post cohort study was conducted over an 8-month period to evaluate the protocol change toward trauma team management of TBI with isolated pneumocephalus and/or subarachnoid hemorrhage (SAH) given a normal neurologic exam (i.e., minimal-risk TBI) without neurosurgery consultation. Demographics of age and Glasgow coma scale (GCS) were collected and expressed in means. Target outcomes consisted of protocol compliance, management compliance (e.g., nursing neurologic checks, thromboembolism prophylaxis, seizure prophylaxis, speech-cognitive testing, follow-up), neurological worsening, increasing therapeutic intensity levels, and TBI-related 30-day readmission. Results Of the 49 patients included, 21 were in the pre-group (age, 54.19 years; GCS, 15) and 28 were in the post-group (age, 52.25 years; GCS, 15). There was 5% and 36% non-compliance with pre- and post-protocol practices in terms of neurosurgery consultation rates. In both pre- and post-periods, management compliance was similar, and none of the TBI patients experienced a worsening neurologic exam, increased therapeutic intensity level, or re-admission. Conclusion Minimal TBI-risk protocol compliance was weaker after the practice change although management compliance and outcomes remained unchanged. This work supports that minimal-risk TBI patients with SAH and normal neurologic exams can be safely managed by trauma teams without neurosurgery consultation. |
| first_indexed | 2024-04-12T07:18:53Z |
| format | Article |
| id | doaj.art-f364b3fd2bcb40cba2d2f17fc46c5028 |
| institution | Directory Open Access Journal |
| issn | 2005-0348 2508-1349 |
| language | English |
| last_indexed | 2024-04-12T07:18:53Z |
| publishDate | 2020-12-01 |
| publisher | The Korean Neurocritical Care Society |
| record_format | Article |
| series | Journal of Neurocritical Care |
| spelling | doaj.art-f364b3fd2bcb40cba2d2f17fc46c50282022-12-22T03:42:23ZengThe Korean Neurocritical Care SocietyJournal of Neurocritical Care2005-03482508-13492020-12-01132808510.18700/jnc.200011328Minimal-risk traumatic brain injury management without neurosurgical consultationElizabeth Starbuck Compton0Benjamin Allan Smallheer1Nicholas Russell Thomason2Michael S. Norris3Mina Faye Nordness4Melissa D. Smith5Mayur Bipin Patel6 Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA School of Nursing, Adult-Gerontology Acute Care Program, Duke University, Durham, NC, USA Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA Division of Trauma, Emergency General Surgery, and Surgical Critical Care, Department of Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USABackground Traumatic brain injury (TBI) with intracranial hemorrhage management results in clinical practice variability, complexity, and/or limitations in acute care surgical and radiological workflow, which can prompt neurosurgical consultation, even when unnecessary. To facilitate an interdisciplinary practice for minimal-risk TBI, our objective was to create and sustain a neurotrauma protocol change that we hypothesized would not result in outcome differences. Methods A retrospective pre-post cohort study was conducted over an 8-month period to evaluate the protocol change toward trauma team management of TBI with isolated pneumocephalus and/or subarachnoid hemorrhage (SAH) given a normal neurologic exam (i.e., minimal-risk TBI) without neurosurgery consultation. Demographics of age and Glasgow coma scale (GCS) were collected and expressed in means. Target outcomes consisted of protocol compliance, management compliance (e.g., nursing neurologic checks, thromboembolism prophylaxis, seizure prophylaxis, speech-cognitive testing, follow-up), neurological worsening, increasing therapeutic intensity levels, and TBI-related 30-day readmission. Results Of the 49 patients included, 21 were in the pre-group (age, 54.19 years; GCS, 15) and 28 were in the post-group (age, 52.25 years; GCS, 15). There was 5% and 36% non-compliance with pre- and post-protocol practices in terms of neurosurgery consultation rates. In both pre- and post-periods, management compliance was similar, and none of the TBI patients experienced a worsening neurologic exam, increased therapeutic intensity level, or re-admission. Conclusion Minimal TBI-risk protocol compliance was weaker after the practice change although management compliance and outcomes remained unchanged. This work supports that minimal-risk TBI patients with SAH and normal neurologic exams can be safely managed by trauma teams without neurosurgery consultation.http://e-jnc.org/upload/pdf/jnc-200011.pdftraumanervous systembrain injuriestraumatic |
| spellingShingle | Elizabeth Starbuck Compton Benjamin Allan Smallheer Nicholas Russell Thomason Michael S. Norris Mina Faye Nordness Melissa D. Smith Mayur Bipin Patel Minimal-risk traumatic brain injury management without neurosurgical consultation Journal of Neurocritical Care trauma nervous system brain injuries traumatic |
| title | Minimal-risk traumatic brain injury management without neurosurgical consultation |
| title_full | Minimal-risk traumatic brain injury management without neurosurgical consultation |
| title_fullStr | Minimal-risk traumatic brain injury management without neurosurgical consultation |
| title_full_unstemmed | Minimal-risk traumatic brain injury management without neurosurgical consultation |
| title_short | Minimal-risk traumatic brain injury management without neurosurgical consultation |
| title_sort | minimal risk traumatic brain injury management without neurosurgical consultation |
| topic | trauma nervous system brain injuries traumatic |
| url | http://e-jnc.org/upload/pdf/jnc-200011.pdf |
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