The American College of Surgeons recommend neurosurgical
evaluation of any patient with a GCS score less than
15 at 2 hours after injury and patients greater than 65 years
of age4 even though less than 1% of patients with MTBI
require neurosurgical intervention.8,9 This requirement creates
a burden on scarce neurosurgical resources, which is
likely to become worse with shortage of neurosurgeons
and aging of the population.10 In fact, there is emerging evidence
that patients with intracranial bleeds can be safely
managed in trauma centers without neurosurgical services,
except in the case of moderate to severe TBI