Abstract | STUDY OBJECTIVE: METHODS: A structured, historical cohort study of adult patients (aged 18 years and older) with minor traumatic intracranial hemorrhage was conducted within a consortium of 8 Level I trauma centers in the western United States from January 2005 to June 2010. The study population included patients with minor traumatic intracranial hemorrhage, defined as an emergency department (ED) Glasgow Coma Scale (GCS) score of 15 (normal mental status) and an Injury Severity Score less than 16 (no other major organ injury). The primary outcome measure was initial ICU admission. The secondary outcome measure was a critical care intervention during hospitalization. Critical care interventions included mechanical ventilation, neurosurgical intervention, transfusion of blood products, vasopressor or inotrope administration, and invasive hemodynamic monitoring. ED disposition and the proportion of ICU patients not receiving a critical care intervention were compared across sites with descriptive statistics. The association between ICU admission and predetermined independent variables was analyzed with multivariable regression. RESULTS: Among 11,240 adult patients with traumatic intracranial hemorrhage, 1,412 (13%) had minor traumatic intracranial hemorrhage and complete ED disposition data (mean age 48 years; SD 20 years). ICU use within this cohort across sites ranged from 50% to 97%. Overall, 847 of 888 patients (95%) with minor traumatic intracranial hemorrhage who were admitted to the ICU did not receive a critical care intervention during hospitalization (range between sites 80% to 100%). Three of 524 (0.6%) patients discharged home or admitted to the observation unit or ward received a critical care intervention. After controlling for severity of injury (age, blood pressure, and Injury Severity Score), study site was independently associated with ICU admission (odds ratios ranged from 1.5 to 30; overall effect P<.001). CONCLUSION:
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Authors | Daniel K Nishijima, Jason S Haukoos, Craig D Newgard, Kristan Staudenmayer, Nathan White, David Slattery, Preston C Maxim, Christopher A Gee, Renee Y Hsia, Joy A Melnikow, James F Holmes |
Journal | Annals of emergency medicine
(Ann Emerg Med)
Vol. 61
Issue 5
Pg. 509-517.e4
(May 2013)
ISSN: 1097-6760 [Electronic] United States |
PMID | 23021347
(Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2012 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved. |
Topics |
- Cohort Studies
- Craniocerebral Trauma
(complications, therapy)
- Female
- Glasgow Coma Scale
- Humans
- Injury Severity Score
- Intensive Care Units
(statistics & numerical data)
- Intracranial Hemorrhages
(etiology, therapy)
- Male
- Middle Aged
- Trauma Centers
(statistics & numerical data)
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