{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T15:12:45Z","timestamp":1792681965234,"version":"4.5.0"},"reference-count":25,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The objective was to identify demographic, clinical, and radiographic risk factors for neurosurgical intervention within 48 hours of admission in patients with mild traumatic brain injury and isolated subdural hematoma.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS <\/jats:title>\n<jats:p>The authors conducted a multicenter retrospective cohort study of all trauma patients admitted to 6 level I\/II trauma centers who met the following criteria: admitted between January 1, 2016, and December 31, 2020, age \u2265 18 years, ICD-10 diagnosis code for isolated subdural hematoma, available initial head imaging, initial Glasgow Coma Scale score of 13\u201315, and arrival at the hospital within 48 hours of injury. Patients were excluded for skull fracture, non\u2013subdural hematoma, and absence of neurosurgical consultation. The study outcome was neurosurgical intervention within 48 hours of hospital admission. Multivariable logistic regression with backward selection examined 30 demographic, clinical, and radiographic risk factors for neurosurgery.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>In total, 1333 patients were included, of whom 117 (8.8%) received a neurosurgical intervention. When only demographic and clinical variables were considered, sex, mechanism of injury, and hours from injury to initial head imaging were significant covariates (area under the receiver operating characteristic curve [AUROC] [95% CI] 0.70 [0.65\u20130.75]). When only radiographic risk factors were considered, only maximum hemorrhage thickness (in mm) and midline shift (in mm) were independent risk factors for the outcome (AUROC 0.95 [0.92\u20130.97]). When all demographic, clinical, and radiographic variables were considered together, advanced directive, Injury Severity Score, midline shift, and maximum hemorrhage thickness were identified as significant risk factors for neurosurgical intervention within 48 hours of hospital admission (AUROC 0.95 [0.94\u20130.97]).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>In the setting of mild traumatic brain injury with isolated subdural hematoma, radiographic risk factors were shown to be stronger than demographic and clinical variables in understanding future risk of neurosurgical intervention. These final radiographic risk factors should be considered in the creation of future prediction models and used to increase the efficiency of existing management guidelines.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.5.jns232476","type":"journal-article","created":{"date-parts":[[2024,8,31]],"date-time":"2024-08-31T01:24:26Z","timestamp":1725067466000},"page":"1-14","source":"Crossref","is-referenced-by-count":2,"title":["Risk factors for neurosurgical intervention within 48 hours of admission for patients with mild traumatic brain injury and isolated subdural hematoma"],"prefix":"10.3171","author":[{"given":"Alessandro","family":"Orlando","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ripul R.","family":"Panchal","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Medical City Plano, Plano, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lane","family":"Mellor","sequence":"additional","affiliation":[{"name":"Department of Trauma Services, St. Anthony Hospital, Lakewood, Colorado;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laxmi","family":"Dhakal","sequence":"additional","affiliation":[{"name":"Departments of Neurology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Hamilton","sequence":"additional","affiliation":[{"name":"Department of Trauma Services, Penrose Hospital, Colorado Springs, Colorado;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenda","family":"Quan","sequence":"additional","affiliation":[{"name":"Department of Trauma Services, Swedish Medical Center, Englewood, Colorado;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timbre","family":"Backen","sequence":"additional","affiliation":[{"name":"Department of Trauma Services, Swedish Medical Center, Englewood, Colorado;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Gordon","sequence":"additional","affiliation":[{"name":"Department of Trauma Services, Swedish Medical Center, Englewood, Colorado;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos H.","family":"Palacio","sequence":"additional","affiliation":[{"name":"Department of Trauma Services, South Texas Health System, McAllen, Texas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Kerby","sequence":"additional","affiliation":[{"name":"Radiology, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gina M.","family":"Berg","sequence":"additional","affiliation":[{"name":"Trauma Research, Wesley Medical Center, Wichita, Kansas;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew Stewart","family":"Levy","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Colorado Permanente Medical Group, Denver, Colorado; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Rubin","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Colorado Permanente Medical Group, Denver, Colorado; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josef","family":"Coresh","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Bar-Or","sequence":"additional","affiliation":[{"name":"Injury Outcomes Research, Englewood, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Surveillance Report of Traumatic Brain Injury-related Emergency Department Visits, Hospitalizations, and Deaths: United States, 2014","article-title":"Centers for Disease Control and Prevention, National Center for Injury Prevention and Control","author":"Peterson AB","year":"2019","unstructured":"Peterson AB, Xu L, Daugherty J, Breiding MJ. Surveillance Report of Traumatic Brain Injury-related Emergency Department Visits, Hospitalizations, and Deaths: United States, 2014. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2019. Accessed June 6, 2024. https:\/\/www.cdc.gov\/traumaticbraininjury\/pdf\/TBI-Surveillance-Report-FINAL_508.pdf"},{"issue":"Suppl 1","key":"b2","series-title":"Inj Prev","first-page":"A268","article-title":"Traumatic brain injury in the United States: national estimates of prevalence and incidence, 2002-2006","volume":"16","author":"Faul M","year":"2010","unstructured":"Faul M, Xu L, Wald MM, Coronado V, Dellinger AM. Traumatic brain injury in the United States: national estimates of prevalence and incidence, 2002-2006. Inj Prev. 2010;16(Suppl 1):A268."},{"key":"b3","series-title":"World Neurosurg","first-page":"94","article-title":"Epidemiology of mild traumatic brain injury with intracranial hemorrhage: focusing predictive models for neurosurgical intervention","volume":"107","author":"Orlando A","year":"2017","unstructured":"Orlando A, Levy AS, Carrick MM, Tanner A, Mains CW, Bar-Or D. Epidemiology of mild traumatic brain injury with intracranial hemorrhage: focusing predictive models for neurosurgical intervention. World Neurosurg. 2017;107:94\u2013102."},{"issue":"1","key":"b4","series-title":"Neurotrauma Rep","first-page":"137","article-title":"Significant national declines in neurosurgical intervention for mild traumatic brain injury with intracranial hemorrhage: a 13-year review of the National Trauma Data Bank","volume":"4","author":"Orlando A","year":"2023","unstructured":"Orlando A, Coresh J, Carrick MM,  Significant national declines in neurosurgical intervention for mild traumatic brain injury with intracranial hemorrhage: a 13-year review of the National Trauma Data Bank. Neurotrauma Rep. 2023;4(1):137\u2013148."},{"issue":"5","key":"b5","series-title":"J Neurotrauma","first-page":"703","article-title":"The risk of deterioration in GCS13-15 patients with traumatic brain injury identified by computed tomography imaging: a systematic review and meta-analysis","volume":"35","author":"Marincowitz C","year":"2018","unstructured":"Marincowitz C, Lecky FE, Townend W, Borakati A, Fabbri A, Sheldon TA. The risk of deterioration in GCS13-15 patients with traumatic brain injury identified by computed tomography imaging: a systematic review and meta-analysis. J Neurotrauma. 2018;35(5):703\u2013718."},{"issue":"5","key":"b6","series-title":"J Trauma Acute Care Surg","first-page":"1363","article-title":"American College of Surgeons\u2019 Committee on Trauma, International ATLS working group. Advanced trauma life support (ATLS\u00ae): the ninth edition","volume":"74","year":"2013","unstructured":"ATLS Subcommittee. American College of Surgeons\u2019 Committee on Trauma, International ATLS working group. Advanced trauma life support (ATLS\u00ae): the ninth edition. J Trauma Acute Care Surg. 2013;74(5):1363\u20131366."},{"issue":"1","key":"b7","series-title":"BMC Med","first-page":"50","article-title":"Scandinavian guidelines for initial management of minimal, mild and moderate head injuries in adults: an evidence and consensus-based update","volume":"11","author":"Und\u00e9n J","year":"2013","unstructured":"Und\u00e9n J, Ingebrigtsen T, Romner B. Scandinavian guidelines for initial management of minimal, mild and moderate head injuries in adults: an evidence and consensus-based update. BMC Med. 2013;11(1):50."},{"issue":"5 Suppl 4","key":"b8","series-title":"J Trauma Acute Care Surg","first-page":"S307","article-title":"Evaluation and management of mild traumatic brain injury: an Eastern Association for the Surgery of Trauma practice management guideline","volume":"73","author":"Barbosa RR","year":"2012","unstructured":"Barbosa RR, Jawa R, Watters JM,  Evaluation and management of mild traumatic brain injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S307\u2013S314."},{"issue":"6","key":"b9","series-title":"J Trauma Acute Care Surg","first-page":"1504","article-title":"Patients with traumatic subarachnoid hemorrhage are at low risk for deterioration or neurosurgical intervention","volume":"74","author":"Borczuk P","year":"2013","unstructured":"Borczuk P, Penn J, Peak D, Chang Y. Patients with traumatic subarachnoid hemorrhage are at low risk for deterioration or neurosurgical intervention. J Trauma Acute Care Surg. 2013;74(6):1504\u20131509."},{"key":"b10","series-title":"World J Emerg Surg","first-page":"23","article-title":"Prediction of neurosurgical intervention after mild traumatic brain injury using the National Trauma Data Bank","volume":"10","author":"Sweeney TE","year":"2015","unstructured":"Sweeney TE, Salles A, Harris OA, Spain DA, Staudenmayer KL. Prediction of neurosurgical intervention after mild traumatic brain injury using the National Trauma Data Bank. World J Emerg Surg. 2015;10:23."},{"issue":"1","key":"b11","series-title":"Acad Emerg Med","first-page":"2","article-title":"Performance of the Canadian CT Head Rule and the New Orleans Criteria for predicting any traumatic intracranial injury on computed tomography in a United States Level I trauma center","volume":"19","author":"Papa L","year":"2012","unstructured":"Papa L, Stiell IG, Clement CM,  Performance of the Canadian CT Head Rule and the New Orleans Criteria for predicting any traumatic intracranial injury on computed tomography in a United States Level I trauma center. Acad Emerg Med. 2012;19(1):2\u201310."},{"issue":"5","key":"b12","series-title":"Ann Emerg Med","first-page":"521","article-title":"Prediction value of the Canadian CT head rule and the New Orleans criteria for positive head CT scan and acute neurosurgical procedures in minor head trauma: a multicenter external validation study","volume":"61","author":"Bouida W","year":"2013","unstructured":"Bouida W, Marghli S, Souissi S,  Prediction value of the Canadian CT head rule and the New Orleans criteria for positive head CT scan and acute neurosurgical procedures in minor head trauma: a multicenter external validation study. Ann Emerg Med. 2013;61(5):521\u2013527."},{"issue":"1-2","key":"b13","series-title":"World Neurosurg","first-page":"e319","article-title":"Outcomes of a nontransfer protocol for mild traumatic brain injury with abnormal head computed tomography in a rural hospital setting","volume":"82","author":"Levy AS","year":"2014","unstructured":"Levy AS, Orlando A, Salottolo K, Mains CW, Bar-Or D. Outcomes of a nontransfer protocol for mild traumatic brain injury with abnormal head computed tomography in a rural hospital setting. World Neurosurg. 2014;82(1-2):e319\u2013e323."},{"issue":"5","key":"b14","series-title":"J Neurosurg","first-page":"1616","article-title":"Isolated subdural hematomas in mild traumatic brain injury. Part 1: the association between radiographic characteristics and neurosurgical intervention","volume":"130","author":"Orlando A","year":"2018","unstructured":"Orlando A, Levy AS, Rubin BA,  Isolated subdural hematomas in mild traumatic brain injury. Part 1: the association between radiographic characteristics and neurosurgical intervention. J Neurosurg. 2018;130(5):1616\u20131625."},{"issue":"11","key":"b15","series-title":"Acad Emerg Med","first-page":"1377","article-title":"A decision instrument to identify isolated traumatic subdural hematomas at low risk of neurologic deterioration, surgical intervention, or radiographic worsening","volume":"24","author":"Pruitt P","year":"2017","unstructured":"Pruitt P, Ornam JV, Borczuk P. A decision instrument to identify isolated traumatic subdural hematomas at low risk of neurologic deterioration, surgical intervention, or radiographic worsening. Acad Emerg Med. 2017;24(11):1377\u20131386."},{"key":"b16","series-title":"World Neurosurg","first-page":"e163","article-title":"External validation of a tool to predict neurosurgery in patients with isolated subdural hematoma","volume":"147","author":"Pruitt P","year":"2021","unstructured":"Pruitt P, Naidech A, Prabhakaran S, Holl JL, Courtney DM, Borczuk P. External validation of a tool to predict neurosurgery in patients with isolated subdural hematoma. World Neurosurg. 2021;147:e163\u2013e170."},{"issue":"1","key":"b17","series-title":"J Trauma Acute Care Surg","first-page":"137","article-title":"Predicting outcomes after traumatic brain injury: the development and validation of prognostic models based on admission characteristics","volume":"73","author":"Yuan F","year":"2012","unstructured":"Yuan F, Ding J, Chen H,  Predicting outcomes after traumatic brain injury: the development and validation of prognostic models based on admission characteristics. J Trauma Acute Care Surg. 2012;73(1):137\u2013145."},{"issue":"10","key":"b18","series-title":"Brain Inj","first-page":"1267","article-title":"Predictors of neurosurgical intervention in complicated mild traumatic brain injury patients: a retrospective cohort study","volume":"35","author":"Tourigny JN","year":"2021","unstructured":"Tourigny JN, Paquet V, Fortier \u00c9,  Predictors of neurosurgical intervention in complicated mild traumatic brain injury patients: a retrospective cohort study. Brain Inj. 2021;35(10):1267\u20131274."},{"issue":"7","key":"b19","series-title":"J Neurotrauma","first-page":"1080","article-title":"Central versus local radiological reading of acute computed tomography characteristics in multi-center traumatic brain injury research","volume":"36","author":"Vande Vyvere T","year":"2019","unstructured":"Vande Vyvere T, Wilms G, Claes L,  Central versus local radiological reading of acute computed tomography characteristics in multi-center traumatic brain injury research. J Neurotrauma. 2019;36(7):1080\u20131092."},{"issue":"4","key":"b20","series-title":"J Trauma Acute Care Surg","first-page":"965","article-title":"The BIG (brain injury guidelines) project: defining the management of traumatic brain injury by acute care surgeons","volume":"76","author":"Joseph B","year":"2014","unstructured":"Joseph B, Friese RS, Sadoun M,  The BIG (brain injury guidelines) project: defining the management of traumatic brain injury by acute care surgeons. J Trauma Acute Care Surg. 2014;76(4):965\u2013969."},{"issue":"5","key":"b21","series-title":"J Neurosurg","first-page":"1626","article-title":"Isolated subdural hematomas in mild traumatic brain injury. Part 2: a preliminary clinical decision support tool for neurosurgical intervention","volume":"130","author":"Orlando A","year":"2018","unstructured":"Orlando A, Levy AS, Rubin BA,  Isolated subdural hematomas in mild traumatic brain injury. Part 2: a preliminary clinical decision support tool for neurosurgical intervention. J Neurosurg. 2018;130(5):1626\u20131633."},{"issue":"5","key":"b22","series-title":"J Trauma Acute Care Surg","first-page":"1247","article-title":"Cumulative incidence and predictors of neurosurgical interventions following nonsevere traumatic brain injury with mildly abnormal head imaging findings","volume":"73","author":"Wu C","year":"2012","unstructured":"Wu C, Orringer DA, Lau D, Fletcher JJ. Cumulative incidence and predictors of neurosurgical interventions following nonsevere traumatic brain injury with mildly abnormal head imaging findings. J Trauma Acute Care Surg. 2012;73(5):1247\u20131253."},{"issue":"1","key":"b23","series-title":"Neurotrauma Rep","first-page":"149","article-title":"Characterizing interhospital variability in neurosurgical interventions for patients with mild traumatic brain injury and intracranial hemorrhage","volume":"4","author":"Orlando A","year":"2023","unstructured":"Orlando A, Coresh J, Carrick MM,  Characterizing interhospital variability in neurosurgical interventions for patients with mild traumatic brain injury and intracranial hemorrhage. Neurotrauma Rep. 2023;4(1):149\u2013158."},{"key":"b24","series-title":"J Surg Res","first-page":"137","article-title":"Risk factors associated with neurosurgical intervention in patients with mild traumatic intracranial hemorrhage","volume":"283","author":"Patel PD","year":"2023","unstructured":"Patel PD, Broadwin M, Stansbury T,  Risk factors associated with neurosurgical intervention in patients with mild traumatic intracranial hemorrhage. J Surg Res. 2023;283:137\u2013145."},{"key":"b25","article-title":"Annual Call for Data","unstructured":"Annual Call for Data. National Trauma Data Bank, American College of Surgeons. Accessed June 6, 2024. https:\/\/www.facs.org\/quality-programs\/trauma\/quality\/national-trauma-data-bank\/annual-call-for-data-national-trauma-data-bank-ntdb\/"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/aop\/article-10.3171-2024.5.JNS232476\/article-10.3171-2024.5.JNS232476.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/aop\/article-10.3171-2024.5.JNS232476\/article-10.3171-2024.5.JNS232476.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/aop\/article-10.3171-2024.5.JNS232476\/article-10.3171-2024.5.JNS232476.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,1]],"date-time":"2025-02-01T01:19:10Z","timestamp":1738372750000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/aop\/article-10.3171-2024.5.JNS232476\/article-10.3171-2024.5.JNS232476.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,1]]},"references-count":25,"URL":"https:\/\/doi.org\/10.3171\/2024.5.jns232476","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,1]]}}}