Predictors of neurosurgical intervention in complicated mild traumatic brain injury patients: a retrospective cohort study

ABSTRACT

Objectives

To determine the predicting demographic, clinical and radiological factors for neurosurgical intervention in complicated mild traumatic brain injury (mTBI) patients.

Methods

Design: retrospective multicenter cohort study. Participants: patients aged ≥16 presenting to all level-I trauma centers in Quebec between 09/2016 and 12/2017 with mTBI(GCS 13–15) and complication on initial head CT (intracranial hemorrhage/skull fracture). Procedure: Consecutive medical records were reviewed and separated into two groups: no neurosurgical intervention and neurosurgical intervention (NSI). Main outcome: neurosurgical intervention. Analysis: multiple logistic regression model.

Results

Four hundred and seventy-eight patients were included and 40 underwent NSI. One patient had radiological deterioration but no clinical deterioration prior to surgery. Subdural hemorrhage ≥4 mm width (OR:3.755 [95% CI:1.290–10.928]) and midline shift (OR:7.507 [95% CI: 3.317–16.989]) increased the risk of NSI. Subarachnoid hemorrhage was associated with a lower risk of NSI (OR:0.312 [95% CI: 0.136–0.713]). All other intracranial hemorrhages were not associated with NSI.

Conclusion

Radiological deterioration was not associated with the incidence of NSI. Subdural hemorrhage and midline shift should be predicting factors for neurosurgery. Some patients with isolated findings such as subarachnoid hemorrhage could be safely managed in their original center without being transferred to a level-I trauma center.

KEYWORDS:

• Mild traumatic brain injury
• intracranial hemorrhage
• neurosurgical intervention

Acknowledgments

We would like to thank all of the research assistants and medical students who helped with data collection on each site.

Author contributions

MÉ had full access to all the study data and takes responsibility for the integrity of the data and the accuracy of the data analysis. MÉ was also responsible for the design of the study protocol. JNT, VP and ÉF collected the data pertaining to this study. PHC, MÉ & JNT led the statistical analyses and interpreted the data. JNT wrote the manuscript, under the supervision of MÉ, ÉM, CM & PGB. VB, VP, ÉF, PHC, JMC, GC and JLG critically reviewed the manuscript. All authors approve this manuscript.

Additional information

Funding

MÉ has received a research grant from the Centre de recherche sur les soins et les services de première ligne de l’Université Laval (now named VITAM – Centre de recherche en santé durable) (no grant number). The granting institution was in no way involved in the design, data collection and analyses of this study