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Changing Paradigms in the Management of 2184 Traumatic Brain Injury Patients
Bellal Joseph*, Ansab A Haider*, Viraj Pandit*, Andrew Tang*, Narong Kulvatumyou*, Terence O'Keeffe*, Peter Rhee
The University of Arizona, Tucson, AZ

The management of traumatic brain injury (TBI) has been evolving with trends towards management of minimally injured patients with intracranial hemorrhage (ICH) exclusively by trauma surgeons. The aim of this study was to assess safety and use of resources as a result of this change in management.
A prospective 5-year (2009-2014) database on all TBI (skull fracture/ICH on head CT) patients presenting to a Level I trauma center was analyzed for patient demographics, injuries, admission physiology, CT scan results, and hospital outcomes. These records were matched to the institutional registry and hospital financial database.
A total of 2,184 patients were included with mean age 43.4±26.1 years, median Glasgow Coma Scale (GCS) 13 [9-15], and median head-abbreviated injury scale (h-AIS) 3 [2-3]. The distribution of types and size of intracranial bleeds remained unchanged throughout the study period. The proportion of TBI managed exclusively by trauma surgeons increased significantly over the years from 6.8% to 40.1%. (p<0.001). Total number of neurosurgical consultations, head CT scans, hospital length of stay and costs decreased significantly over time. The overall mortality rate (18.5%) remained unchanged.
Figure 1. demonstrates the trends in outcomes.

TBI can be selectively managed without neurosurgeons safely and in a cost effective manner resulting in more effective use of precious resources.

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