Care Paths, Clinical Management and Decision Making in 1638 Mild TBI Patients Presenting to a Neurosurgical Emergency Department

Introduction: Mild traumatic brain injury (TBI) is an increasing phenomenon, partially associated with neurological impairment and reduced quality of life. Given its socioeconomic relevance, assessing whether patients require neuroimaging, monitoring or interventions is becoming increasingly important. We, therefore, aimed to describe clinical management in mild TBI patients presenting to a neurosurgical emergency department (ED).

Methods: All mild TBI patients (GCS 13-15) admitted to the ED of a neurosurgical maximum care provider in Germany were prospectively assessed between April 2021 and October 2022. Demographic and clinical variables were collected and the necessity for neuroimaging, admission to the regular ward/ICU and medical or surgical interventions were analyzed.

Results: Over a period of 19 months, 1638 mild TBI patients could be included (54% male; mean age 52± 25 years). The most common cause of injury was an incidental fall (n=1021; 62%). Neurological deficits were rare (n=80; 5%), but 247 patients (15%) suffered from amnesia and 209 (13%) had experienced vomiting. Antithrombotic medication was taken by 24% of patients (n=390) and 7% (n=121) were under the influence of alcohol. Brain computed tomography (CT) imaging was performed in 68% of cases (n=1111). Intracranial pathologies were observed in 296 patients (27%). Medical or surgical interventions were performed in 645 patients (39%), including e.g., i.v.-analgesia (n=426; 66%), antibiotic treatment (n=64; 10%) and neurosurgery (n=44; 7%). Admission to the normal ward or ICU was deemed necessary in 18% of cases (n=291) with “pathological CT finding” being the most common indication (n=209; 72%) and the mean length of hospital stay being 2 ± 5 days.

Conclusion : Mild TBI is associated with neuroimaging, medical/surgical interventions, and hospital admission in a substantial number of patients presenting to a neurosurgical maximum care provider. Our findings suggest that the causal injuries might be less “mild” than suspected and should raise awareness for their adequate clinical management.