UMEM Educational Pearls

Category: Neurology

Title: Does Everyone with a Traumatic Head Bleed Need to go to the ICU?

Keywords: intracranial hemorrhage, ICU, clinical decision rule (PubMed Search)

Posted: 7/23/2014 by Danya Khoujah, MBBS
Click here to contact Danya Khoujah, MBBS

Maybe not! A new prospective study looked at 600 adult trauma patients presenting with mild traumatic intracranial hemorrhage (with a GCS 13-15), and derived a clinical instrument that predicted the need for a “critical care intervention” (and therefore needing an ICU level of care). These interventions included intubation, neurosurgical intervention and need for invasive monitoring, among other things.

The derived instrument consisted of 4 variables:

1.     GCS less than 15

2.     Non-isolated head injury

3.     Age 65 years or older

4.     Evidence of swelling or shift on the initial head CT

The presence of at least one of these variables predicted the need for critical intervention, identifying 114 of the 116 patients who actually did require it, making it 98.3% sensitive.

This clinical decision rule is yet to be externally validated


Nishijima D K, et al. Derivation of a Clinical Decision Instrument to Identify Adult Patients with Mild Traumatic Intracranial Hemorrhage at Low Risk for Requiring ICU Admission. Ann Emerg Med 63(2014); 448-456