Discharging Patients with Mild Traumatic Intracranial Hemorrhage: A Brief Review

This review seeks to characterize recent evidence of the emergency department (ED) disposition of patients with mild traumatic intracranial hemorrhage (mild tICH).

A growing body of literature demonstrates that patients with mild tICH are at low risk of neurological decompensation requiring emergent intervention. In low-risk cohorts, multiple guidelines now indicate that intensive care unit admission and neurosurgical consultation are generally unnecessary, and select patients can be safely discharged home from the ED. Definitions regarding low-risk patients are heterogeneous but usually consider factors such as the size and location of intracranial bleeding, the patient’s use of anticoagulants or antiplatelets, and the extent of their neurocognitive impairment.

Evolving evidence supports that many patients with mild tICH do not require lengthy and intensive observation or neurosurgical consultation despite historical practice patterns. Certain patients with tICH may be safe for discharge home from the ED.