Redefining Mild Traumatic Brain Injury (mTBI) delineates cost effective triage

Am J Emerg Med. 2020 Jun;38(6):1097-1101. doi: 10.1016/j.ajem.2019.158379. Epub 2019 Jul 29.


Objectives: Mild traumatic brain injury (mTBI) is defined as Glasgow Coma Score (GCS) of 14 or 15. Despite good outcomes, patients are commonly transferred to trauma centers for observation and/or neurosurgical consultation. The aim of this study is to assess the value of redefining mTBI with novel radiographic criteria to determine the appropriateness of interhospital transfer for neurosurgical evaluation.

Methods: A retrospective study of patients with blunt head injury with GCS 13-15 and CT head from Jan 2014-Dec 2016 was performed. A novel criteria of head CT findings was created at our institution to classify mTBI. Outcomes included neurosurgical intervention and transfer cost.

Results: A total of 2120 patients were identified with 1442 (68.0%) meeting CT criteria for mTBI and 678 (32.0%) classified high risk. Two (0.14%) patients with mTBI required neurosurgical intervention compared with 143 (21.28%) high risk TBI (p < 0.0001). Mean age (55.8 years), and anticoagulation (2.6% vs 2.8%) or antiplatelet use (2.1% vs 3.0%) was similar between groups (p > 0.05). Of patients with mTBI, 689 were transferred without receiving neurosurgical intervention. Given an average EMS transfer cost of $700 for ground and $5800 for air, we estimate an unnecessary transfer cost of $733,600.

Conclusion: Defining mTBI with the described novel criteria clearly identifies patients who can be safely managed without transfer for neurosurgical consultation. These unnecessary transfers represent a substantial financial and resource burden to the trauma system and inconvenience to patients.

Keywords: Computed tomography; Interhospital transfer; Neurosurgical; Traumatic brain injury.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Brain Injuries, Traumatic / diagnosis*
  • Brain Injuries, Traumatic / economics
  • Cost-Benefit Analysis
  • Female
  • Hospital Costs*
  • Humans
  • Male
  • Middle Aged
  • Referral and Consultation / economics*
  • Retrospective Studies
  • Tomography, X-Ray Computed / economics
  • Tomography, X-Ray Computed / methods*
  • Trauma Centers*
  • Triage / economics*
  • Triage / methods