The following is a summary of “To observe or not to observe: Evaluation of the modified brain injury guideline management of small volume intracranial hemorrhage,” published in the December 2023 issue of Surgery by Lee, et al.

Patients presenting with small volume intracranial hemorrhage (ICH), categorized as modified Brain Injury Guidelines (mBIG) 1, typically undergo a 6-hour observation period in the emergency department (ED). For this study, researchers sought to characterize the mBIG 1 patient population and assess the necessity of the ED observation period.

A retrospective analysis was conducted on trauma patients diagnosed with small-volume ICH. Exclusion criteria comprised Glasgow Coma Scale (GCS) scores < 13 and penetrating injuries.

Over an 8-year period, 359 patients met the inclusion criteria. Subdural hematoma (SDH) was the most common type of ICH (52.7%), followed by subarachnoid hemorrhage (SAH) (50.1%). Neurological deterioration occurred in two patients (0.56%), but neither exhibited radiographic progression. Radiographic progression was observed in 14.3% of the cohort, with no patients necessitating neurosurgical intervention. Four patients (1.1%) required readmission due to traumatic brain injury (TBI) from the index admission.

Despite some patients demonstrating radiographic or clinical deterioration, no individuals with small-volume ICH required neurosurgical intervention. Therefore, patients meeting mBIG 1 criteria may be safely managed without the need for an ED observation period.

Reference: americanjournalofsurgery.com/article/S0002-9610(23)00276-3/abstract