Management of Minor Traumatic Brain Injury in an ED Observation Unit

Matthew A. Wheatley, MD; Shikha Kapil, MD; Amanda Lewis, MSSc, PA-C; Jessica Walsh O'Sullivan, MD; Joshua Armentrout, MD; Tim P. Moran, PhD; Anwar Osborne, MD, MPM; Brooks L. Moore, MD; Bryan Morse, MD; Peter Rhee, MD; Faiz Ahmad, MD; Hany Atallah, MD


Western J Emerg Med. 2021;22(4):943-950. 

In This Article


We found a significant difference in our primary outcome of EDOU vs inpatient LOS. Management of patients with mTBI in the EDOU was associated with significant reduction in LOS when compared with patients in inpatient settings. This is consistent with the above studies on EDOU vs inpatient care. This finding differs somewhat from the EDOU study by Yun et al in that they did not compare EDOU and inpatient data, but rather the LOS in the ED portion of care only.[37] This difference is not as surprising as the preponderance of other studies showing benefit in LOS for EDOU pathways when compared to usual care in an inpatient setting.

Overall, our protocol is similar to the one reported in the Yun study. There were minor differences in inclusion criteria such as the upper limit of subdural hematoma. Interventions in the EDOU were similar between the two groups including frequent neurologic checks and repeat HCT for clinical deterioration. In addition, we found a low rate of adverse events in the EDOU group, which is consistent with previous studies on minor TIH. None of the patients in the intervention group required emergent neurosurgical intervention. The most common reasons for inpatient admission were persistent symptoms due to head injury or other traumatic or medical issues that presented during the observation period. This is summarized in Table 4. Further study is needed to determine predictors for inpatient conversion in this group.

Patients in the EDOU had a lower rate of neurosurgical consultation and repeat HCT when compared with their inpatient counterparts. Repeat HCTs were ordered based on clinical concern or recommendations from radiology or neurosurgical consultants. Further study is needed to determine the clinical necessity of these interventions in the EDOU setting.