The following is a summary of “To observe or not to observe: Evaluation of the modified brain injury guideline management of small volume intracranial hemorrhage,” published in the June 2023 issue of Surgery by Lee et al.

Patients with small-volume intracranial hemorrhage (ICH) are classified as modified Brain Injury Guidelines (mBIG) 1 and undergo a 6-hour observation period in the emergency department (ED) for management.

For a study, researchers aimed to characterize patient populations falling under mBIG 1 and assess the effectiveness of the ED observation period. They studied trauma patients with ICH. Patients with a Glasgow Coma Scale (GCS) < 13 and those with penetrating injuries were excluded from the study. During the 8-year study duration, a total of 359 patients were identified. The predominant type of ICH observed was subdural hematoma (SDH 52.7%), followed by subarachnoid hemorrhage (SAH 50.1%). Out of the 359 patients, only 2 individuals (0.56%) experienced neurological deterioration, but there was no evidence of radiographic progression in either case.

In the entire cohort, 14.3% of patients exhibited radiographic progression. Still, none of them necessitated neurosurgical intervention, 4 patients (1.1%) were readmitted due to traumatic brain injury (TBI) complications arising from the initial admission.

The study concluded; neurosurgical intervention was necessary for small-volume ICH patients, even with a subset experiencing deterioration. This suggests that mBIG 1 criteria patients can safely manage without an ED observation period.

Source: sciencedirect.com/science/article/abs/pii/S0002961023002763