Abstract：
OBJECTIVE: Approximately 10% of patients with mild traumatic brain injury (mTBI) have intracranial bleeding (complicated mTBI) and 3.5% eventually require neurosurgical intervention, which is mostly available at centers with a higher level of trauma care designation and often requires interhospital transfer. In 2018, the Brain Injury Guidelines (BIG) were updated in the United States to guide emergency department care and patient disposition for complicated mild to moderate TBI. The aim of this study was to validate the sensitivity and specificity of the updated BIG (uBIG) for predicting the need for interhospital transfer in Canadian patients with complicated mTBI.
METHODS: This study took place at three level I trauma centers. Consecutive medical records of patients with complicated mTBI (Glasgow Coma Scale score 13-15) who were aged ≥ 16 years and presented between September 2016 and December 2017 were retrospectively reviewed. Patients with a penetrating trauma and those who had a documented cerebral tumor or aneurysm were excluded. The primary outcome was a combination of neurosurgical intervention and/or mTBI-related death. Sensitivity and specificity analyses were performed.
RESULTS: A total of 477 patients were included, of whom 8.4% received neurosurgical intervention and 3% died as a result of their mTBI. Forty patients (8%) were classified as uBIG-1, 168 (35%) as uBIG-2, and 269 (56%) as uBIG-3. No patients in uBIG-1 underwent neurosurgical intervention or died as a result of their injury. This translates into a sensitivity for predicting the need for a transfer of 100% (95% CI 93.2%-100%) and a specificity of 9.4% (95% CI 6.8%-12.6%). Using the uBIG could potentially reduce the number of transfers by 6% to 25%.
CONCLUSIONS: The patients in uBIG-1 could be safely managed at their initial center without the need for transfer to a center with a higher level of neurotrauma care. Although the uBIG could decrease the number of transfers, further refinement of the criteria could improve its specificity.
METHODS: This study took place at three level I trauma centers. Consecutive medical records of patients with complicated mTBI (Glasgow Coma Scale score 13-15) who were aged ≥ 16 years and presented between September 2016 and December 2017 were retrospectively reviewed. Patients with a penetrating trauma and those who had a documented cerebral tumor or aneurysm were excluded. The primary outcome was a combination of neurosurgical intervention and/or mTBI-related death. Sensitivity and specificity analyses were performed.
RESULTS: A total of 477 patients were included, of whom 8.4% received neurosurgical intervention and 3% died as a result of their mTBI. Forty patients (8%) were classified as uBIG-1, 168 (35%) as uBIG-2, and 269 (56%) as uBIG-3. No patients in uBIG-1 underwent neurosurgical intervention or died as a result of their injury. This translates into a sensitivity for predicting the need for a transfer of 100% (95% CI 93.2%-100%) and a specificity of 9.4% (95% CI 6.8%-12.6%). Using the uBIG could potentially reduce the number of transfers by 6% to 25%.
CONCLUSIONS: The patients in uBIG-1 could be safely managed at their initial center without the need for transfer to a center with a higher level of neurotrauma care. Although the uBIG could decrease the number of transfers, further refinement of the criteria could improve its specificity.
摘要：
目的：大约10%的轻度创伤性脑损伤（mTBI）患者出现颅内出血（并发mTBI），3.5%最终需要神经外科手术治疗。这主要是在创伤护理指定水平较高的中心，并且通常需要医院间转院。2018年，美国更新了脑损伤指南（BIG），以指导复杂的轻度至中度TBI的急诊科护理和患者处置。这项研究的目的是验证更新的BIG（uBIG）的敏感性和特异性，以预测患有复杂mTBI的加拿大患者是否需要院际转移。
方法：本研究在三个一级创伤中心进行。回顾性分析2016年9月至2017年12月期间年龄≥16岁的复杂mTBI患者（格拉斯哥昏迷量表评分13-15）的连续医疗记录。排除穿透性创伤患者和有记录的脑肿瘤或动脉瘤的患者。主要结果是神经外科介入和/或mTBI相关死亡的组合。进行敏感性和特异性分析。
结果：共纳入477例患者，其中8.4%的人接受了神经外科手术，3%的人死于mTBI。40名患者(8%)被分类为uBIG-1,168名(35%)被分类为uBIG-2,269名(56%)被分类为uBIG-3。uBIG-1中没有患者接受神经外科手术或因受伤而死亡。这转化为预测转移需求的敏感性为100%(95%CI93.2%-100%)和特异性为9.4%(95%CI6.8%-12.6%)。使用uBIG可能会将转移次数减少6％至25％。
结论：uBIG-1患者可以在其初始中心安全管理，而无需转移到神经创伤护理水平较高的中心。尽管uBIG可以减少转移的数量，进一步完善标准可以提高其特异性.
方法：本研究在三个一级创伤中心进行。回顾性分析2016年9月至2017年12月期间年龄≥16岁的复杂mTBI患者（格拉斯哥昏迷量表评分13-15）的连续医疗记录。排除穿透性创伤患者和有记录的脑肿瘤或动脉瘤的患者。主要结果是神经外科介入和/或mTBI相关死亡的组合。进行敏感性和特异性分析。
结果：共纳入477例患者，其中8.4%的人接受了神经外科手术，3%的人死于mTBI。40名患者(8%)被分类为uBIG-1,168名(35%)被分类为uBIG-2,269名(56%)被分类为uBIG-3。uBIG-1中没有患者接受神经外科手术或因受伤而死亡。这转化为预测转移需求的敏感性为100%(95%CI93.2%-100%)和特异性为9.4%(95%CI6.8%-12.6%)。使用uBIG可能会将转移次数减少6％至25％。
结论：uBIG-1患者可以在其初始中心安全管理，而无需转移到神经创伤护理水平较高的中心。尽管uBIG可以减少转移的数量，进一步完善标准可以提高其特异性.
