Delineation of Criteria for Admission to Step Down in the Mild Traumatic Brain Injury Patient

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Patients that suffer a mild traumatic brain injury with intracranial hemorrhage are commonly admitted to an ICU with repeat imaging in 12–24 hours. This is costly to the healthcare system. This study aimed to evaluate this practice and to identify criteria to triage patients to lower levels of monitored care. A retrospective review was performed at a university based level I trauma center. Patients with mild TBI were included. Data was collected on demographics, neurologic status at 6, 12 and 24 hours, CT scan results, and medical or surgical interventions required. 389 patients were evaluated, 53 had a documented neurologic decline while admitted. Factors found to be associated with a neurologic decline included GCS<15 (p=0.002), age greater than 55 (p<0.001), and warfarin use (p=0.039). Aspirin and Plavix were not associated with neurologic decline. No patient age<55 with a GCS of 15 had a documented decline. Several risk factors were found to be associated with neurological decline after mild TBI. These include age>, GCS<15, and warfarin use. Patients age<55 with GCS 15, posed minimal risk for deterioration. Patients age <55 and with a GCS of 15 can be admitted to a monitored step-down bed with less frequent neurologic checks.