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Research Article

Retrospective analysis of small intracranial hemorrhage in trauma: Is acute care surgery team management alone safe?

Shyam Muralia Department of Emergency Medicine, Mercy Health St. Vincent Medical Center, Toledo, Ohio, USA

Farjana Alamb Department of Academic Affairs, Medical Student, Mercy Health St. Vincent Medical Center, Toledo, Ohio, USA, Northeast Ohio Medical University, Rootstown, Ohio, USA

Jenna Kroekerc Department of Academic Affairs, Medical Student, Mercy Health St. Vincent Medical Center, Toledo, Ohio, USA, St. George's University School of Medicine, Great River, New York, USA;d Department of General Surgery Residency Program, Maimonides Medical Center, Brooklyn, New York, USA

https://orcid.org/0000-0002-0751-9599

Jennifer Ginsbergc Department of Academic Affairs, Medical Student, Mercy Health St. Vincent Medical Center, Toledo, Ohio, USA, St. George's University School of Medicine, Great River, New York, USA

https://orcid.org/0000-0003-0342-475X

Erin Obergc Department of Academic Affairs, Medical Student, Mercy Health St. Vincent Medical Center, Toledo, Ohio, USA, St. George's University School of Medicine, Great River, New York, USA

Phillip Woodruffc Department of Academic Affairs, Medical Student, Mercy Health St. Vincent Medical Center, Toledo, Ohio, USA, St. George's University School of Medicine, Great River, New York, USA

Aaron N. Mooree Department of Trauma & Critical Care Surgery, Trauma Surgeon, Mercy Health St. Vincent Medical Center, Toledo, Ohio, USA

Anthony Jay Raimondee Department of Trauma & Critical Care Surgery, Trauma Surgeon, Mercy Health St. Vincent Medical Center, Toledo, Ohio, USA

Rachel Novakovicf Department of Trauma & Critical Care Surgery, Trauma Surgeon, Medical Director Burn Center, Mercy Health St. Vincent Medical Center, Toledo, Ohio, USA

Nancy M. Budererg Department of Academic Affairs, Contracted Statistician, Nancy Buderer Consulting, LLC, Oak Harbor, Ohio, USA

https://orcid.org/0000-0002-8187-2710

Julie M. Stausmireh Department of Academic Affairs, Academic Research Coordinator, Julie M. Stausmire, Mercy Health St. Vincent Medical Center, Toledo, Ohio, USACorrespondence[email protected]

https://orcid.org/0000-0003-2592-4093

John J. Leskovani Department of Trauma & Critical Care Surgery, Trauma Medical Director, Trauma Surgeon, Mercy Health St. Vincent Medical Center, Toledo, Ohio, USA

https://orcid.org/0000-0003-1204-0555

Amer Afanehe Department of Trauma & Critical Care Surgery, Trauma Surgeon, Mercy Health St. Vincent Medical Center, Toledo, Ohio, USA

https://orcid.org/0000-0002-4331-577X

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ABSTRACT

Background: The Brain Injury Guidelines (BIG) provide a validated framework for categorizing patients with small intracranial haemorrhages (ICH) who could be managed by acute care surgery without neurosurgical consultation or repeat head computed tomography in the absence of neurological deterioration. This replication study retrospectively applied BIG criteria to ICH subjects and only included BIG1 and BIG2 subjects.

Methods: The trauma registry was queried from 2014 to 2019 for subjects with a traumatic ICH <1 cm, Glasgow Coma Scale score of 14/15 and not on anticoagulation therapy. Patients were then categorized under BIG 1 or BIG2 and outcomes were evaluated.

Results: Two hundred fourteen subjects were reviewed (88 BIG1 and 126 BIG2). Twenty-three subjects had worse repeat imaging, but only one had worsening exam that resolved spontaneously. None required neurosurgical intervention. One died of non-neurological causes.

Conclusions: Retrospective analysis supported our hypothesis that patients categorized as BIG1 or BIG2 could have been safely managed by acute care surgeons without neurosurgical consultation or repeat head imaging. A review of minor worsening on repeat imaging without changes in neurological exams and no need for neurosurgical interventions supports this evidence-based approach to the management of small intracranial haemorrhages.

KEYWORDS:

Acknowledgments

The authors would like to acknowledge Lisa Nichols, Library Coordinator, for her outstanding assistance with every literature search, no matter how small or how large the project. Mercy Health St. Vincent Medical Center, Toledo, OH [email protected]

Disclosure statement

This research has not been previously published and is not under consideration by any other journal. None of the author(s) have any conflicts of interest to report.

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Retrospective analysis of small intracranial hemorrhage in trauma: Is acute care surgery team management alone safe?

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Retrospective analysis of small intracranial hemorrhage in trauma: Is acute care surgery team management alone safe?

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