Management of the mild traumatic brain injured patient using a multidisciplinary observation unit protocol

• Published in: The American journal of emergency medicine Vol. 46; pp. 176 - 182
• Main Authors: Rhame, Katherine, Le, Diana, Ventura, Amanda, Horner, Amy, Andaluz, Norberto, Miller, Christopher, Stolz, Uwe, Ngwenya, Laura B., Adeoye, Opeolu, Kreitzer, Natalie
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2021; Elsevier Limited
• Subjects: Cognitive ability; Concussion; Coronary artery disease; Emergency; Emergency medical care; Heart diseases; Hematoma; Hemorrhage; Hospitals; Medical imaging; Medicine; Mild traumatic brain injury; Mortality; Multidisciplinary teams; Neurosurgery; Nursing; Observation medicine; Occupational therapy; Patients; Physical therapy; Regression analysis; Speech therapy; Trauma; Traumatic brain injury; United States > US; Concussion; Observation medicine; Mild traumatic brain injury
• ISSN: 0735-6757; 1532-8171; 1532-8171
• DOI: 10.1016/j.ajem.2020.06.088

We developed an ED based multidisciplinary observation unit (OU) protocol for patients with mild traumatic brain injury (mTBI). We describe the cohort of patients who were placed in the ED OU and we evaluated if changes to our inclusion and exclusion criteria should be made. We conducted a retrospective cohort study to evaluate subjects who were admitted to the mTBI observation protocol. We included adults within 24 h of sustaining an mTBI with a Glasgow Coma Scale (GCS) of 14 or 15 who had pre-specified head CT findings, and did not meet exclusion criteria. Predictors of need for hospital admission after completing the OU protocol were determined using multivariable logistic regression analysis. The mean age was 49 (SD 23), 58 (33%) were female, and 136 (78%) were Caucasian. No subjects discharged home required a surgical intervention or ICU admission, and there were no deaths in discharged or admitted subjects. 28 subjects (16%) were admitted to the hospital following their OU stay. Subjects admitted were older (mean age: 56 vs. 48, p = 0.1) and had a higher proportion of traumatic bleeds on head CT (85% vs. 76%, p = 0.3). In multivariable logistic regression, GCS of 15 (aOR 4.24), African-American race (aOR 5.84), and no comorbid cardiac disease predicted discharge home after the observation protocol (aOR 0.28). A period of observation for a pre-defined cohort of patients with mTBI provided a triage plan that could allow appropriate patient management without requiring admission in the majority of subjects.