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The American College of Surgeons recommend neurosurgicalevaluation of any patient with a GCS score less than15 at 2 hours after injury and patients greater than 65 yearsof age4 even though less than 1% of patients with MTBIrequire neurosurgical intervention.8,9 This requirement createsa burden on scarce neurosurgical resources, which islikely to become worse with shortage of neurosurgeonsand aging of the population.10 In fact, there is emerging evidencethat patients with intracranial bleeds can be safelymanaged in trauma centers without neurosurgical services,except in the case of moderate to severe TBI
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