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. 2024 Oct:302:679-684.
doi: 10.1016/j.jss.2024.07.113. Epub 2024 Aug 28.

Outcomes of Traumatic Brain Injury Patients Managed in a Non-Intensive Care Unit Setting

David Roberge Bouchard  1 , Madison Harris  2 , John Getchell  2 , Vani Parthiban  2 , Arielle Brackett  2 , Joseph Sciacca  2 , Joseph Kuiper  2 , Richard Caplan  2 , Luis Cardenas  2 , Asanthi Ratnasekera  2 , Jonathan Imran  2
Affiliations

Outcomes of Traumatic Brain Injury Patients Managed in a Non-Intensive Care Unit Setting

David Roberge Bouchard et al. J Surg Res. 2024 Oct.

Abstract

Introduction: The management of traumatic brain injury (TBI) requires significant health-care resources. The modified Brain Injury Guidelines (mBIG) stratifies TBI patients by severity to help guide disposition and management. We sought to analyze the outcomes of TBI patients managed in a non-intensive care unit (ICU) setting after stratifying them using the mBIG criteria.

Methods: A retrospective single-center study was performed on all adult patients who sustained blunt TBI from 2021 to 2022 and were managed in a non-ICU setting. Primary outcome was unplanned upgrade to the ICU. Secondary outcomes were need for neurosurgical intervention, unplanned intubation, mortality, and hospital length of stay. Patients were divided into cohorts of mBIG 1 & 2 versus mBIG 3.

Results: Of the 274 patients managed in a non-ICU setting, 119 (43.4%) met mBIG 3 criteria. The majority (76.5%) were managed in a step-down level of care. Nine patients required upgrade to the ICU, with only two upgraded for acute progression of their intracranial hemorrhage. Eight patients in mBIG 3 cohort required neurosurgical interventions, with only two related to progression of their intracranial hemorrhage and both over 24 h after admission. The remaining six patients had planned delayed neurosurgical intervention. Unplanned intubation occurred in three patients with only one related to a delayed progression of their TBI. Longer hospitalization and decreased survival were noted in mBIG 3 group. No differences in 30-d readmissions, stroke, venous thromboembolism events or seizures were found between the two groups.

Conclusions: Select patients with severe TBI may be considered for admission to step-down units with frequent neurologic exams in lieu of ICU level of care.

Keywords: Brain injury guidelines; Intensive care unit (ICU); Traumatic brain injury.

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Figures

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Fig. –
mBIG.8 All patients were diagnosed with a TBI, had a GCS of 13–15, and had no focal neurologic or pupillary findings. All antiplatelets except aspirin (ASA) were used for classification. SDH = subdural hematoma; IPH = intraparenchymal hemorrhage; SAH = subarachnoid hemorrhage; EDH = edural hematoma; IVH = intraventricular hematoma; EtOH = elevated blood alcohol level.
See this image and copyright information in PMC

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