Admissions for isolated non-operative mild head injuries: Sharing the burden among trauma surgery, neurosurgery, and neurology.

Admissions for isolated non-operative mild head injuries: Sharing the burden among trauma surgery, neurosurgery, and neurology.

J Trauma Acute Care Surg. 2016 Apr 26;

Authors: Zhao T, Mejaddam AY, Chang Y, DeMoya MA, King DR, Yeh DD, Kaafarani HM, Alam HB, Velmahos GC

Abstract
BACKGROUND: Isolated non-operative mild head injuries (INOMHI) occur with increasing frequency in an aging population. These patients often have multiple social, discharge and rehabilitation issues, which far exceed the acute component of their care. This study aims to compare the outcomes of patients with INOMHI admitted to three services: Trauma Surgery, Neurosurgery, and Neurology.
METHODS: Retrospective case series (01/01/2009-08/31/2013) at an academic Level I Trauma Center. According to an institutional protocol, INOMHI patients with Glasgow Coma Scale (GCS) of 13-15 were admitted on a weekly rotational basis to Trauma Surgery, Neurosurgery, and Neurology. The three populations were compared and the primary outcomes were survival rate to discharge, neurological status at hospital discharge as measured by the Glasgow Outcome Score (GOS), and discharge disposition.
RESULTS: Four hundred and eighty-eight INOMHI patients were admitted (Trauma Surgery 172; Neurosurgery 131; Neurology 185). The mean age of the study population was 65.3 years and 58.8% of patients were male. Seventy-seven percent of patients has a GCS score of 15. Age, gender, mechanism of injury, Charlson Comorbidity Index, Injury Severity Score, Abbreviated Injury Scale in head and neck, and GCS were similar among three groups. Patients who were admitted to Trauma Surgery, Neurosurgery and Neurology services had similar proportions of survivors (98.8% vs 95.7% vs 94.7%), and discharge disposition (Home: 57.0% vs 61.6% vs 55.7%). The proportion of patients with GOS of 4 or 5 on discharge was slightly higher among patients admitted to Trauma (97.7% vs 93.0% vs 92.4%). In a logistic regression model adjusting for CCI and AIS head and neck score, patients who were admitted to Neurology or Neurosurgery had significantly lower odds being discharged with GOS 4 or 5. While Trauma group had the lowest proportion of repeat brain CT (61.6%), Neurosurgery group had the highest proportion of ICU admission (29.8%), and Neurology group had the longest ED stay (7.5 h), there were no significant differences in duration of hospital stay, in-hospital complications and readmission within 30 days.
CONCLUSIONS: Although there were differences in utilization of health care resources, and the proportion of patients with GOS of 4 or 5 on discharge was slightly higher among patients admitted to Trauma, the majority of clinical outcomes were similar in INOMHI patients admitted to Trauma Surgery, Neurosurgery, or Neurology in our institution. A rotational policy of admitting INOMHI patients is feasible among services with expertise in and commitment to the care of these patients.
LEVEL OF EVIDENCE: IV, therapeutic/care management.

PMID: 27116408 [PubMed - as supplied by publisher]

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