The following is a summary of “Identification and management of low-risk isolated traumatic brain injury patients initially treated at a rural level IV trauma center,” published in the April 2024 issue of Emergency Medicine by Nene, et al.

For a retrospective observational analysis, researchers sought to investigate whether low-risk, patients with isolated mild traumatic brain injury (TBI) initially treated at a rural emergency department could be safely managed without transfer to a tertiary referral trauma center.

The study retrospectively analyzed patients with isolated mild TBI transferred from a rural Level IV Trauma Center to a regional Level I Trauma Center between 2018 and 2022. Patients were risk-stratified using the modified Brain Injury Guidelines (mBIG). Data from the electronic medical record, including patient presentation, management, and outcome, were collected.

Among the 250 transferred patients with isolated mild TBI, falls were the most common mechanism of injury (69.2%). About 28 patients (11.2%) were categorized as low-risk (mBIG1). None of the mBIG1 patients experienced progression of neurological injury, worsening of intracranial hemorrhage on repeat head CT, or required neurosurgical intervention. Approximately 42.9% of patients with mBIG1 had a hospital length of stay of 2 days or less, primarily for observation. Longer stays were attributed to medical complications or difficulty arranging disposition.

The study suggested that patients meeting mBIG1 criteria for isolated mild TBI may be safely observed without transfer to a Level I Trauma Center. The approach could benefit patients by allowing them to remain in their community and improve regional resource utilization.

Reference: sciencedirect.com/science/article/pii/S0735675724000159