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Related Experiment Video

Updated: Sep 28, 2025

Murine Model of Controlled Cortical Impact for the Induction of Traumatic Brain Injury
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Management of Minor Traumatic Brain Injury in an ED Observation Unit.

Matthew A Wheatley1,2, Shikha Kapil3, Amanda Lewis1,2

  • 1Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia.

The Western Journal of Emergency Medicine
|March 30, 2022
PubMed
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Emergency department observation units can safely manage patients with minor traumatic intracranial hemorrhages (TIH) using a specific protocol, significantly reducing hospital length of stay and unnecessary consultations.

Area of Science:

  • Emergency Medicine
  • Neurosurgery
  • Trauma Surgery

Background:

  • Traditionally, traumatic intracranial hemorrhages (TIH) required intensive care unit (ICU) admission, neurosurgery consultation, and repeat head CTs (HCT).
  • Recent evidence suggests select patients with minor TIH and normal neurological exams may not need intensive care or extensive monitoring.
  • Emergency department observation units (EDOU) offer a potential alternative for managing these patients safely.

Purpose of the Study:

  • To evaluate the safety and efficacy of an emergency department observation unit (EDOU) protocol for managing minor traumatic brain injuries (mTBI).
  • To assess the impact of the protocol on length of stay, neurosurgical consultations, and repeat head CTs compared to historical controls.

Main Methods:

  • Retrospective cross-sectional study at a Level I trauma center evaluating an EDOU protocol for mTBI based on Brain Injury Guidelines (BIG).

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  • Patients meeting BIG 1 or BIG 2 criteria were managed in the EDOU with routine monitoring and discretionary consultations.
  • Comparison with historical inpatient controls admitted for TIH prior to protocol implementation.

    • Main Results:

    • The EDOU group (169 patients) had a median length of stay of 24.8 hours versus 60.2 hours for the inpatient control group (53 patients) (P < .001).
    • Fewer repeat HCTs (27.8% vs 75.5%) and neurosurgical consultations (62.7% vs 100%) were performed in the EDOU group.
    • Only 7.1% of EDOU patients required hospital admission, and none needed emergent neurosurgical intervention.

    Conclusions:

    • An EDOU protocol for minor traumatic intracranial hemorrhages (TIH) is effective in reducing length of stay.
    • This approach allows for discretionary neurosurgical consultations and repeat head CTs, improving resource utilization.
    • Patients with minor TIH can be safely managed in an EDOU, avoiding unnecessary intensive care and interventions.