Not every trauma patient with a radiographic head injury requires transfer for neurosurgical evaluation: Application of the brain injury guidelines to patients transferred to a level 1 trauma center

• Published in: The American journal of surgery Vol. 214; no. 6; pp. 1182 - 1185
• Main Authors: Capron, Gweniviere Kayla, Voights, Mary Beth, Moore, Henry R., Wall, Derek B.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2017; Elsevier Limited
• Subjects: Adult; Anticoagulants; Brain; Brain Injuries - classification; Brain Injuries - diagnostic imaging; Brain Injuries - surgery; Consciousness; Emergency medical care; Evaluation; Female; Fractures; Glasgow Coma Scale; Guideline Adherence; Guidelines; Head injuries; Hemorrhage; Humans; Illinois; Injuries; Injury prevention; Injury Severity Score; Intervention; Male; Middle Aged; Neurosurgery; Neurosurgical Procedures; Patient transfer; Patient Transfer - economics; Patient Transfer - statistics & numerical data; Patients; Practice Guidelines as Topic; Regional analysis; Retrospective Studies; Rural areas; Rural hospital; Surgeons; Surgery; Trauma; Trauma Centers; Traumatic brain injury; Rural hospital; Patient transfer; Traumatic brain injury
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2017.09.002

Patients with radiographically-identified traumatic brain injury are often transferred to our regional trauma center for neurosurgical evaluation, yet few injuries require neurosurgical intervention. Transfer is costly, inconvenient, and potentially risky in inclement weather. We propose that previously-published brain injury guidelines (BIG)1 can help to determine which patients could avoid mandatory transfer. Retrospective chart review of patients transferred between January 2012 and December 2013 was performed. Patients were classified as having minor (BIG 1), moderate (BIG 2), or severe (BIG 3) head injuries based on previously-published guidelines. Patient characteristics and outcomes were compared. No BIG 1 patients deteriorated or required surgical intervention. One BIG 2 patient required a non-emergent operation and another was readmitted with a worsened injury. In the BIG 3 group, 11.9% required neurosurgical procedures and 20% died. The BIG classification can help stratify patients for whom transfer is considered.