Can We Identify Patients with Traumatic Intracranial Hemorrhage Who Don't Need Aggressive Care?

Patients with traumatic intracranial hemorrhage are often admitted to an intensive care unit, regardless of the severity of their injury. To identify predictors of need for critical care, investigators prospectively studied adults with mild traumatic intracranial hemorrhage (initial Glasgow Coma Scale [GCS] score ≥13) who presented to a level 1 trauma center in California. Patients using anticoagulants were excluded.

Of 600 patients, 19% underwent a critical care intervention, which was defined as transfusion, mechanical ventilation, neurosurgery, invasive monitoring, treatment for arrhythmia or cardiac arrest, pressor use, or angiography. Recursive partitioning methods identified four characteristics that predicted need for intervention: GC…