Structural Versus Physiologic Drivers of Surgical Escalation, Critical Care Utilization, and Disposition in Isolated Traumatic Brain Injury

Structural Versus Physiologic Drivers of Surgical Escalation, Critical Care Utilization, and Disposition in Isolated Traumatic Brain Injury | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Structural Versus Physiologic Drivers of Surgical Escalation, Critical Care Utilization, and Disposition in Isolated Traumatic Brain Injury Heather X Rhodes-Lyons, David L. McClure, Taylor Locklear, Lucy Martinek, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8672720/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background In traumatic brain injury (TBI), radiographic thresholds guide surgical decisions, while physiologic criteria determine intracranial pressure (ICP) monitoring. Whether these same features predict critical care needs and post-acute discharge outcomes remains uncertain. We studied lesion-specific and size-dependent factors that influence neurosurgical escalation, intensive care unit (ICU) length of stay, and discharge pathways in adults with isolated blunt TBI without skull fracture. Methods We performed a retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program Participant Use File (2017–2022). Adults aged ≥ 15 years with isolated blunt TBI and no skull fracture or moderate-to-severe extracranial injury (AIS > 1 in non-head regions) were included. Lesions were classified by AIS-derived morphology and a modified Berne–Norwood framework. Multivariable logistic regression estimated adjusted odds ratios (ORs) for craniotomy, ICP monitoring, and discharge to rehabilitation or hospice. Multivariable linear regression assessed predictors of ICU length of stay, adjusting for demographics, injury severity, system-level factors, and comorbidities. Results Among 451,754 patients, isolated subarachnoid hemorrhage (35.0%) and subdural hematoma (SDH) ≤ 8 mm (30.8%) were most common. Large SDH (> 8 mm) was strongly linked to craniotomy (OR 5.44, 95% CI 5.26–5.62) and ICP monitoring (OR 2.04, 95% CI 1.95–2.14). Diffuse axonal injury (DAI) was inversely related to craniotomy (OR 0.20, 95% CI 0.15–0.26) but positively related to ICP monitoring (OR 1.50, 95% CI 1.34–1.68). DAI predicted longer ICU stays (β + 4.08 days, 95% CI 2.82–5.33), while large contusions (> 2 cm) were linked to discharge to hospice (OR 1.55, 95% CI 1.15–2.10; all values p < 0.01). Conclusions In isolated blunt TBI, focal, size-dependent lesions influence surgical decisions, while diffuse injury patterns impact extended ICU stays and recovery or end-of-life choices. Lesion characteristics enable early assessment of surgical needs, resource requirements, and post-acute care strategies, supporting lesion-specific neurocritical care planning. Neurocritical Care Brain Injuries Traumatic Hemorrhage Treatment Outcome Figures Figure 1 DETAILS PAGE 1. Confirm that the manuscript complies with all instructions to authors This manuscript fully complies with the Neurocritical Care Instructions for Authors. The work adheres to the journal’s standards for original research articles, including formatting, word limits, figure and table requirements, and ethical reporting practices. 2. Detailed description of individual author contributions All authors meet the authorship criteria as defined by the International Committee of Medical Journal Editors (ICMJE). Each author has made substantial contributions to the conception or design of the study, data acquisition, analysis, or interpretation; has participated in drafting or revising the manuscript for important intellectual content; has provided final approval of the version to be published; and agrees to be accountable for all aspects of the work. 3. Confirm that authorship requirements (see below) have been met and the final manuscript was approved by all authors All authors have reviewed and approved the final version of the manuscript before submission. 4. Confirm that this manuscript has not been published elsewhere and is not under consideration by another journal This manuscript has not been published previously in any form and is not under consideration by any other journal. 5. Confirm adherence to ethical guidelines and indicate ethical approvals (IRB) and use of informed consent, as appropriate. Retrospective studies require a statement regarding IRB approval This study was reviewed by the Marshfield Clinic Research Institute Institutional Review Board (IRB) and determined to be exempt from oversight in accordance with federal regulations governing research with de-identified data (IRB Protocol RHO10224). The research involved a retrospective analysis of a limited, de-identified dataset; therefore, informed consent was not required. All study procedures complied with the ethical standards of the institutional and national research committees and with the principles of the Declaration of Helsinki. 6. Disclose Conflicts of Interest for all authors The authors declare no conflicts of interest relevant to this work. None of the authors has financial, professional, or personal relationships that could inappropriately influence the conduct or reporting of the study. 7. Confirm the use of the reporting checklist, if appropriate This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cohort studies. A completed STROBE checklist is included in the supplementary material. 8. Sources of Funding Funding for this project was provided in part through philanthropic support of the Marshfield Clinic Research Institute, led by the Marshfield Clinic Health System Foundation (Grant #255800-00-RES SUPPT TRAUMA). No external commercial funding was received. INTRODUCTION Traumatic brain injury (TBI) remains a leading cause of death and long-term disability worldwide, with an estimated 2.8 million emergency department visits, hospitalizations, and deaths each year in the United States alone. 1 , 2 Despite advances in neurocritical care and trauma systems, significant variability still exists in how patients with similar intracranial injury patterns are triaged, monitored, and treated across different centers. 3 – 5 This variation is especially apparent in the growing population of adults presenting with isolated TBI without skull fracture, a population that increasingly includes an aging demographic, those with multiple health conditions, and injuries caused mostly by low-energy falls rather than high-velocity trauma. 6 , 7 Contemporary clinical practice in TBI is guided by a dual framework that separates surgically treatable structural lesions from diffuse or physiologic injuries that require extended neurocritical care. The Brain Trauma Foundation (BTF) guidelines highlight the importance of prompt surgical removal for focal mass lesions linked to neurological decline or radiographic signs of mass effect, while also recommending intracranial pressure (ICP) monitoring for patients at high risk of intracranial hypertension based on Glasgow Coma Scale (GCS), imaging findings, and clinical course. 8 , 9 This approach reflects longstanding biomechanical and neuropathological observations that focal hematomas, such as acute subdural and epidural collections, mainly threaten outcomes through compressive and herniation-related mechanisms, whereas diffuse axonal injury (DAI) and global cerebral edema involve widespread network disruption and impaired autoregulation that are not suitable for surgical correction. 10 – 12 Evidence supporting this conceptual separation has grown across both surgical and neurocritical care literature. Operative timing and lesion size significantly influence outcomes in acute subdural and parenchymal hematomas, underscoring size-dependent thresholds for neurosurgical intervention. 13 – 15 In contrast, physiologic markers of secondary brain injury, including sustained intracranial hypertension and impaired cerebral perfusion, are more closely linked to longer ICU stays and long-term functional dependence. 16 , 17 DAI, in particular, has become a key predictor of ongoing neurologic disability and delayed recovery, even when initial imaging shows no large focal lesions. 18 , 19 While these areas of injury biology and clinical management are often discussed separately, they are rarely studied together within a single framework that covers operative escalation, critical care use, and post-acute care decisions. Large-scale observational studies have mainly focused on mortality, neurosurgical intervention, or functional outcomes alone, rather than exploring how different injury types influence the entire care process from admission to discharge. 5 , 20 This gap is becoming more important in modern trauma systems, where resource allocation, ICU capacity, and access to rehab and hospice services face increasing pressure, especially for older adults and those with significant baseline vulnerabilities. 6 , 7 , 21 Classification systems like the Abbreviated Injury Scale (AIS) and modern TBI phenotyping frameworks aim to improve injury classification for targeted treatments and prognosis. 22 , 23 However, these methods have not been consistently incorporated into real-world neurosurgical decision-making and neurocritical care practices. Consequently, it is still unclear whether the anatomical features that influence surgical thresholds are the same ones that cause extended physiologic instability and loss of functional independence. OBJECTIVE Using a large, national trauma registry, we studied adults with isolated TBI without skull fracture to assess how lesion type and size, physiologic severity, and patient-level factors differently predict three important care outcomes: neurosurgical escalation, critical care use, and hospital discharge plans. We hypothesized that focal, size-dependent lesions would primarily influence surgical and monitoring decisions, whereas diffuse and physiologic injury types would more strongly affect ICU length of stay and subsequent transfers to rehabilitation or hospice. By connecting these areas within a unified framework, this study aims to clarify how well current practice follows guideline-based approaches and to identify injury profiles that might benefit from earlier, more personalized post-acute care pathways. METHODS Study Design and Data Source This retrospective cohort study examined data from the American College of Surgeons Trauma Quality Improvement Program Participant Use File (ACS-TQIP-PUF) covering 2017 to 2022. The dataset includes de-identified patient records submitted to the National Trauma Data Bank by over 700 trauma centers across the United States, representing various facility verification levels (Level I–V and undesignated), teaching status, and ownership types. 20 Informed consent was not required because the data was fully de-identified. The study was classified as exempt from full institutional review by the [RHO10224] Institutional Review Board, in line with federal regulations for secondary analysis of existing datasets. Reporting followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines (Supplementary Table 1). Study Population and Eligibility Criteria The analytic cohort consisted of adults aged 15 years and older who experienced an isolated blunt TBI between January 1, 2017, and December 31, 2022 (Fig. 1 ). Blunt mechanism was defined using ACS-TQIP mechanism-of-injury codes and excluded penetrating trauma. To minimize clinical variability and better attribute neurosurgical decision-making to intracranial pathology, patients with any skull fracture were excluded. Skull fractures involve distinct care pathways related to cerebrospinal fluid leakage, infection risk, and direct injury to cerebral vessels and tissue, which may independently necessitate operative or monitoring interventions. To further isolate intracranial injury burden, patients with moderate to severe extracranial trauma were excluded, defined as an AIS severity score greater than 1 in any non-head body region (Regions 2–6: face, chest, abdomen, pelvis, extremities, or external; Supplemental Table 2). This criterion limited the cohort to patients without clinically significant multisystem injury, thereby reducing confounding factors such as hemorrhagic shock, competing operative priorities, or extended critical care caused by non-neurologic organ failure. AIS coding adhered to the 2015 Revision, 6th Edition.23 Lesion Classification and Reference Groups TBI lesion morphology and size were classified using AIS head region codes from computed tomography scans performed within the first 24 hours of admission. Patients were grouped into mutually exclusive lesion phenotypes using a modified Berne–Norwood framework that employs clinically meaningful radiographic thresholds for mass effect and progression risk. 12 Lesion subgroups included: subdural hematoma (SDH) ≤ 8 mm and > 8 mm, epidural hematoma (EDH) ≤ 8 mm and > 8 mm, cerebral contusion ≤ 2 cm and > 2 cm in maximum diameter, isolated subarachnoid hemorrhage (SAH), diffuse axonal injury (DAI), and subpial hemorrhage. Patients with more than one intracranial lesion type were classified as multifocal. For regression modeling, the reference group comprised patients with non-isolated SAH (N = 82,502) and those with multifocal TBI (N = 7,295), reflecting a clinically heterogeneous population in which neither focal mass lesions nor isolated diffuse injury predominated. Covariates and Variable Definitions Covariates were selected a priori based on biological plausibility and prior research linking demographic, clinical, and system-level factors to neurosurgical interventions, critical care utilization, and post-acute disposition. Variables taken from the ACS-TQIP-PUF included: Demographic and Socioeconomic Factors age, sex, race (African American, American Indian/Alaska Native, Asian, Caucasian, other), ethnicity (Hispanic or Latino), insurance status (Medicare, Medicaid, private/commercial, self-pay/other), trauma center verification level, teaching status, and hospital ownership (for-profit vs. non-profit). Prehospital and system-level features mechanism of injury (including fall as a predefined category), mode of transport (ground ambulance, helicopter, private vehicle/other), and transfer status. Injury Severity and Neurologic Status initial Glasgow Coma Scale score, Injury Severity Score, AIS scores by body region (head, face, chest, abdomen, pelvis, extremities, external), presence of midline shift on CT imaging, and presence of subpial hemorrhage. Comorbid Conditions advanced directive status, alcohol use disorder, anticoagulation therapy, attention deficit hyperactivity disorder, bleeding disorders, prior cerebrovascular accident, active chemotherapy, chronic obstructive pulmonary disease, cirrhosis, congestive heart failure, current smoking status, dementia, diabetes mellitus, disseminated malignancy, functional dependency, hypertension, documented mental health diagnosis, and chronic renal failure. Procedural and temporal variables include the performance of a craniotomy, the placement of an intracranial pressure (ICP) monitor, and the timing of ICP monitor placement, measured in hours from hospital arrival. Outcomes of Interest The primary outcomes were neurosurgical escalation, defined as performing a craniotomy and/or placing an ICP monitor during the initial hospitalization. Secondary outcomes included intensive care unit (ICU) length of stay in days and hospital discharge disposition, categorized as rehabilitation or hospice. These outcomes were chosen to reflect three clinically distinct but related areas of care: operative decision-making, physiologic support and monitoring intensity, and post-acute recovery or end-of-life trajectory. Unlike traditional severity-based methods, this analysis explicitly stratified patients by radiographic lesion morphology and size, allowing assessment of how focal structural injury versus diffuse physiologic injury phenotypes independently influence procedural care, resource use, and subsequent disposition pathways. Statistical Analysis Descriptive analyses were conducted to characterize the study population and lesion subgroups, with continuous variables summarized as medians and interquartile ranges and categorical variables presented as frequencies and proportions. Differences across TBI phenotypes were assessed using the Kruskal–Wallis test for continuous variables and Pearson’s chi-square test for categorical variables, as shown in Supplementary Table 3–5. Before multivariable modeling, all candidate predictors were evaluated for multicollinearity using variance inflation factors and tolerance statistics, with a tolerance threshold of > 0.5 to ensure model stability and proper variable independence. Variables meeting these criteria were included in the final models. Statistical significance was defined as a two-sided p-value < 0.05. Descriptive analyses were performed using R version 4.4.1 (R Core Team, Vienna, Austria). Four main multivariable regression models were specified to match each analytic domain listed in the primary and supplementary tables. Neurosurgical Escalation Models : Two separate multivariable logistic regression models were developed to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the relationship between lesion phenotype and (a) performing a craniotomy and (b) placing an ICP monitor (Table 1). Critical Care Utilization Model : A multivariable linear regression was constructed to identify predictors of ICU length of stay in days, including lesion subtype, timing of ICP monitor placement, demographic and system-level factors, injury severity metrics, and comorbid conditions (Table 2 ). Discharge Disposition Models : Two multivariable logistic regression models were used to estimate adjusted ORs and 95% CIs for hospital discharge to (a) inpatient rehabilitation and (b) hospice care (Table 3 ). Table 1. Logistic Regression Analysis Of Factors Associated With A Craniotomy and Intracranial Monitoring Among Adults (≥ 15 Years) That Experienced An Isolated Traumatic Brain Injury Without A Skull Fracture. Craniotomy Intracranial Monitoring Effect OR 94% CI Lower-Upper p-value OR 94% CI Lower-Upper p-value Isolated SDH ≤8mm 0.34 0.32­–0.35 <0.01 0.31 0.29–0.33 8mm 5.44 5.26–5.62 <0.01 2.04 1.95–2.14 <0.01 Isolated EDH ≤8mm 0.43 0.35–0.53 <0.01 0.26 0.18–0.38 8mm 4.80 4.24–5.44 <0.01 1.15 0.91–1.46 0.22 Isolated Contusion ≤2cm 0.03 0.02–0.05 <0.01 0.11 0.08–0.15 2cm 0.79 0.59–1.07 0.13 1.47 1.10–1.97 <0.01 Isolated SAH 0.08 0.08–0.09 <0.01 0.31 0.30–0.33 0.02 Isolated DAI 0.20 0.15–0.26 <0.01 1.50 1.34–1.68 <0.01 Sex (Male) 1.21 1.18–1.25 <0.01 1.34 1.28–1.40 <0.01 Race (Caucasian) 0.82 0.79–0.85 <0.01 0.80 0.77–0.83 <0.01 Hispanic or Latino 1.17 1.12–1.23 <0.01 1.26 1.18–1.33 <0.01 Fall Mechanism 1.33 1.28–1.39 <0.01 0.78 0.74–0.81 <0.01 Insurance (Medicare) 0.89 0.86–0.92 <0.01 0.77 0.74–0.81 <0.01 Ground Ambulance 0.79 0.77–0.82 <0.01 0.92 0.89–0.97 <0.01 Glasgow Coma Scale 0.91 0.91–0.92 <0.01 0.84 0.83–0.84 <0.01 Comorbidities Advanced Directive 0.74 0.70–0.79 <0.01 0 .75 0.68–0.82 <0.01 Alcohol Use Disorder 1.36 1.30–1.42 <0.01 1.00 0.94–1.07 0.82 Anticoagulation 1.03 0.99–1.06 0.07 0.83 0.79–0.88 <0.01 ADHD 0.95 0.78–1.14 0.59 1.14 0.92–1.40 0.21 Bleeding Disorder 1.13 1.04–1.23 <0.01 1.02 0.90–1.17 0.69 CVA 1.06 1.01–1.12 0.02 1.08 1.00–1.18 0.05 Chemotherapy 0.82 0.71–0.94 <0.01 0.78 0.62–0.97 0.02 COPD 0.99 0.94–1.04 0.70 0.91 0.84–0.98 0.02 Cirrhosis 0.91 0.84–1.00 0.05 1.01 0.89–1.13 0.86 CHF 0.98 0.93–1.04 0.62 1.02 0.94–1.11 0.51 Current Smoker 1.04 1.00–1.08 0.04 0.96 0.91–1.01 0.18 Dementia 0.60 0.57–0.63 <0.01 0.68 0.63–0.74 <0.01 Diabetes 1.01 0.97–1.04 0.49 0.98 0.93–1.03 0.49 Disseminating Cancer 0.76 0.67–0.86 <0.01 0.75 0.62–0.90 <0.01 FDHS 0.85 0.81–0.88 <0.01 0.85 0.79–0.91 <0.01 Hypertension 1.13 1.10–1.17 <0.01 1.04 0.99–1.08 0.07 Mental Health Diagnosis 1.07 1.03–1.12 <0.01 1.04 0.98–1.10 0.19 Renal Failure 1.10 1.03–1.19 <0.01 1.12 1.01–1.25 0.03 Note: SDH=subdural hematoma, EDH=epidural hematoma, SAH=subarachnoid hemorrhage, DAI=diffuse axonal injury, AIS=abbreviated injury severity, ADHD=attention deficit hyperactivity disorder, CVA=cerebral vascular accident, COPD=chronic obstructive pulmonary disease, CHF=congestive heart failure, FDHS=functional dependent health status, ICP=intracranial pressure Reference Group: non-isolated SAH (N=82,502) and multi-focal traumatic brain injury (N=7,295) Table 2 Linear Regression Analysis of Factors Associated With Intensive Care Unit Length Of Stay in Days Among Adults (≥ 15 Years) That Experienced An Isolated Traumatic Brain Injury Without A Skull Fracture. Effect Estimate 95% CI Lower–Upper p-value Isolated SDH ≤8mm -1.75 -1.99–-1.50 8mm -0.26 -0.58–-0.06 0.11 Isolated EDH ≤8mm -1.62 -2.62–-0.62 8mm -1.20 -2.75–0.34 0.12 Isolated Contusion ≤2cm -2.07 -2.69–-1.44 2cm -0.30 -2.49–1.88 0.78 Isolated SAH -1.51 -1.75–-1.27 < 0.01 Isolated DAI 4.08 2.82–5.33 < 0.01 ICP Monitor Timing (hours) 0.01 0.01–0.01 < 0.01 Sex (Male) 0.34 0.16–0.52 < 0.01 Race (Caucasian) -0.39 -0.61–-0.17 < 0.01 Hispanic or Latino -0.05 -0.36–0.24 0.72 Fall Mechanism -0.43 -0.66–-0.21 < 0.01 Insurance (Medicare) -0.15 -0.35–0.05 0.14 Ground Ambulance -0.05 -0.26–0.15 0.60 Glasgow Coma Scale -0.43 -0.46–-0.41 < 0.01 Comorbidities Advanced Directive -0.44 -0.82–-0.06 0.02 Alcohol Use Disorder 0.55 0.23–0.86 < 0.01 Anticoagulation -0.11 -0.33–0.10 0.31 ADHD 0.29 -0.74–1.32 0.57 Bleeding Disorder 0.18 -0.42–0.78 0.55 CVA -0.00 -0.37–0.35 0.96 Chemotherapy -0.13 -0.97–0.70 0.75 COPD 0.23 -0.08–0.55 0.14 Cirrhosis 0.56 -0.03–1.17 0.06 CHF 0.36 0.02–0.70 0.03 Current Smoker -0.04 -0.30–0.20 0.70 Dementia 0.22 0.00–0.43 0.04 Disseminating Cancer -0.27 -1.03–0.48 0.47 FDHS 0.00 -0.25–0.26 0.98 Hypertension 0.08 -0.11–0.27 0.40 Mental Health Diagnosis -0.05 -0.31–0.21 0.69 Renal Failure 0.56 0.06–1.06 0.02 Note: SDH=subdural hematoma, EDH=epidural hematoma, SAH=subarachnoid hemorrhage, DAI=diffuse axonal injury, AIS=abbreviated injury severity, ADHD=attention deficit hyperactivity disorder, CVA=cerebral vascular accident, COPD=chronic obstructive pulmonary disease, CHF=congestive heart failure, FDHS=functional dependent health status, ICP=intracranial pressure, S.E.=standard error, C.I.=confidence interval Reference Group: non-isolated SAH (N = 82,502) and multi-focal traumatic brain injury (N = 7,295) Table 3 Logistic Regression Analysis Of Factors Associated With Hospital Discharge Disposition to Rehabilitation and Hospice Among Adults (≥ 15 Years) That Experienced An Isolated Traumatic Brain Injury Without A Skull Fracture. Rehabilitation Hospice Effect OR 94% CI Lower-Upper p-value OR 94% CI Lower-Upper p-value Isolated SDH ≤8mm 0.61 0.60–0.63 < 0.01 0.46 0.43–0.48 8mm 1.11 1.07–1.14 < 0.01 1.16 1.10–1.22 < 0.01 Isolated EDH ≤8mm 0.64 0.57–0.73 < 0.01 0.44 0.33–0.59 8mm 0.85 0.72–1.01 0.06 0.74 0.53–1.03 0.08 Isolated Contusion ≤2cm 0.53 0.49–0.58 < 0.01 0.34 0.28–0.43 2cm 0.78 0.61–0.99 0.04 1.55 1.15–2.10 < 0.01 Isolated SAH 0.65 0.63–0.67 < 0.01 0.51 0.48–0.54 < 0.01 Isolated DAI 2.74 2.49–3.01 < 0.01 0.87 0.64–1.17 0.37 Sex (Male) 1.06 1.04–1.08 < 0.01 1.08 1.04–1.12 < 0.01 Race (Caucasian) 1.09 1.06–1.12 < 0.01 1.08 1.04–1.12 < 0.01 Hispanic or Latino 0.72 0.69–0.75 < 0.01 1.37 1.29–1.45 < 0.01 Fall Mechanism 0.86 0.84–0.88 < 0.01 2.76 2.54–3.00 < 0.01 Insurance (Medicare) 1.33 1.30–1.36 < 0.01 1.60 1.58–1.74 < 0.01 Ground Ambulance 0.98 0.96–1.01 0.35 1.18 1.12–1.24 < 0.01 Glasgow Coma Scale 0.95 0.95–0.96 < 0.01 0.87 0.87–0.88 < 0.01 Comorbidities Advanced Directive 0.68 0.65–0.71 < 0.01 2.51 2.39–2.63 < 0.01 Alcohol Use Disorder 1.14 1.10–1.18 < 0.01 0.80 0.62–0.75 < 0.01 Anticoagulation 1.07 1.05–1.10 < 0.01 1.17 1.12–1.22 < 0.01 ADHD 1.09 0.97–1.22 0.14 0.84 0.58–1.21 0.36 Bleeding Disorder 1.05 0.98–1.12 0.14 1.27 1.14–1.40 < 0.01 CVA 1.22 1.17–1.27 < 0.01 1.20 1.12–1.28 < 0.01 Chemotherapy 0.84 0.76–0.93 < 0.01 2.04 1.81–2.29 < 0.01 COPD 1.01 0.98–1.05 0.30 1.07 1.01–1.14 0.02 Cirrhosis 0.90 0.84–0.96 < 0.01 2.06 1.85–2.28 < 0.01 CHF 0.97 0.93–1.01 0.16 1.33 1.50–1.14 < 0.01 Current Smoker 0.85 0.82–0.87 < 0.01 0.79 0.73–0.85 < 0.01 Dementia 0.70 0.67–0.72 < 0.01 2.83 2.70–2.95 < 0.01 Diabetes 1.08 1.06–1.11 <0.01 0.96 0.92–1.00 0.10 Disseminating Cancer 0.82 0.75–0.89 < 0.01 3.21 2.91–3.53 < 0.01 FDHS 1.28 1.25–1.32 < 0.01 1.05 1.00–1.09 0.02 Hypertension 1.22 1.19–1.25 < 0.01 1.05 1.00–1.09 0.02 Mental Health Diagnosis 1.08 1.05–1.11 < 0.01 0.80 0.76–0.85 < 0.01 Renal Failure 0.91 0.86–0.96 < 0.01 1.12 1.02–1.23 0.01 Note: SDH=subdural hematoma, EDH=epidural hematoma, SAH=subarachnoid hemorrhage, DAI=diffuse axonal injury, AIS=abbreviated injury severity, ADHD=attention deficit hyperactivity disorder, CVA=cerebral vascular accident, COPD=chronic obstructive pulmonary disease, CHF=congestive heart failure, FDHS=functional dependent health status, ICP=intracranial pressure Reference Group: non-isolated SAH (N = 82,502) and multi-focal traumatic brain injury (N = 7,295) Across all models, the main independent variables were TBI lesion type and size, classified using AIS-derived morphology among patients with isolated blunt TBI without skull fracture. Covariates included age, sex, race, ethnicity, mechanism of injury, insurance status, trauma center characteristics, mode of transport, initial Glasgow Coma Scale score, Injury Severity Score, AIS scores by body region, presence of midline shift, timing of ICP monitor placement, and pre-existing comorbidities as specified above. The reference group for all regression analyses consisted of patients with non-isolated SAH (N = 82,502) and multifocal traumatic brain injury (N = 7,295), representing a clinically heterogeneous cohort in which neither focal mass lesions nor isolated diffuse injury predominated. Final multivariable models were executed using SPSS version 28 (IBM Corp., Armonk, NY). RESULTS Section I. Descriptive Characteristics and Clinical Proportional Differences Descriptive characteristics of the study population are summarized in Supplementary Tables 3–5, which detail patient demographics (Table 3 ), comorbid conditions (Table 4), and injury-related factors and clinical outcomes (Table 5) for adults with isolated blunt TBI without skull fracture. The analytic cohort included 451,754 patients, with isolated SAH being the most common lesion phenotype (35.0%), followed by SDH ≤ 8 mm (30.8%), and non-isolated SAH (18.2%). Lesion subtypes associated with greater mass effect were less common, including SDH > 8 mm (10.4%) and EDH > 8 mm (0.3%), but showed significant differences in clinical severity and downstream care patterns. The median age across the cohort was 70 years (interquartile range [IQR] 24), with significant differences in age by lesion type (p 8 mm) tended to be older (median 75 years, IQR 17), while those with DAI were notably younger (median 33 years, IQR 30), reflecting different injury mechanisms and baseline risks. Male patients comprised the majority (55.8%) and were disproportionately represented among those with EDH > 8 mm (67.6%) and DAI (76.4%), aligning with high-energy injury mechanisms in these subgroups. Racial and ethnic distributions varied significantly across lesion categories (p 8 mm and contusions > 2 cm, and private or commercial insurance is more frequently observed in younger groups, including those with EDH and DAI. The mechanism of injury showed a clear lesion-specific pattern. Falls made up the majority of injuries in patients with SDH > 8 mm (89.9%) and isolated SAH, highlighting the dominance of low-energy mechanisms in older adults. Conversely, high-energy mechanisms, such as motor vehicle and motorcycle collisions, were more common in patients with EDH and DAI, consistent with their younger age and higher rates of helicopter transport. Helicopter transport was used in 27.8% of patients with DAI and 13.2% of those with SDH > 8 mm, with significantly lower rates among patients with smaller hemorrhages. Comorbidity burden varied significantly by lesion phenotype (Supplementary Table 4). Hypertension (54.8%) and dementia (10.7%) were common throughout the cohort, with higher rates among patients with larger SDH and contusions exceeding 2 cm. Anticoagulant use was most frequent in patients with SDH over 8 mm (33.3%) and multifocal injuries (24.7%), indicating a possible role in the development and progression of hemorrhagic lesions. Advanced directives were more common among older patients and those with high-risk hemorrhagic phenotypes, reflecting baseline vulnerability and goals-of-care considerations. Injury severity metrics showed clear proportional differences across lesion subtypes (p 8 mm and SDH > 8 mm had the highest Injury Severity Scores (mean 26.4 [SD 2.3] and 25.9 [SD 1.6], respectively) and maximum Head AIS scores of 5, indicating critical head injury. These patients also experienced the highest rates of neurosurgical escalation, such as craniotomy and early ICP monitoring. Conversely, patients with isolated SAH and contusions ≤ 2 cm had notably lower injury severity score values (mean 7.9 [SD 4.9] and 9.5 [SD 4.0]) and Head AIS scores closer to 3, reflecting serious but not life-threatening injuries. Neurologic status at presentation further differentiated lesion phenotypes. Median Glasgow Coma Scale scores were lowest among patients with DAI (median 4, IQR 5), indicating severe neurologic dysfunction and diffuse injury. Patients with SDH > 8 mm also showed lower GCS scores (median 15, IQR 5), while those with small-volume hemorrhages and isolated SAH generally presented with nearly normal neurologic status. Clinical outcomes varied consistently by lesion size and type, providing important context for subsequent multivariable analyses. ICU length of stay was longest for patients with DAI (median 11.2 days, IQR 9.5) and SDH greater than 8 mm (median 4.4 days, IQR 3.3), compared to shorter stays in patients with isolated SAH and small contusions. Rates of ICP monitor placement and craniotomy increased progressively with lesion size, especially for SDH and EDH, while discharge to rehabilitation was most common for patients with DAI. Hospice discharge was more frequently seen among patients with large contusions and high comorbidity burden. These proportional differences highlight the clinical gradient linking lesion morphology with neurosurgical escalation, critical care needs, and downstream disposition, as examined in the adjusted regression models. Section II: Multivariable Regression Analyses Across Surgical, Critical Care, and Disposition Domains Neurosurgical Escalation: Craniotomy and ICP Monitoring (Table 1) Multivariable logistic regression demonstrated a pronounced, size-dependent association between focal hemorrhagic lesion morphology and operative intervention. Relative to the reference group, large SDH (> 8 mm) were associated with the highest adjusted odds of craniotomy (OR 5.44, 95% CI 5.26–5.62; p 8 mm; OR 4.80, 95% CI 4.24–5.44; p < 0.01). In contrast, small-volume SDH (≤ 8 mm) and EDH (≤ 8 mm) were independently associated with substantially lower odds of craniotomy (OR 0.34, 95% CI 0.32–0.35 and OR 0.43, 95% CI 0.35–0.53, respectively; both p < 0.01). Associations with ICP monitoring showed a clear pattern. Large SDH was linked to a higher likelihood of monitor placement (OR 2.04, 95% CI 1.95–2.14; p < 0.01), while large EDH was not (OR 1.15, 95% CI 0.91–1.46; p = 0.22). DAI had a significant positive association with ICP monitoring (OR 1.50, 95% CI 1.34–1.68; p < 0.01), despite being inversely related to craniotomy (OR 0.20, 95% CI 0.15–0.26; p < 0.01). Isolated subarachnoid hemorrhage and contusions ≤ 2 cm were linked to decreased odds of both surgical intervention and monitoring. Critical Care Utilization: ICU Length of Stay (Table 2 ) In the multivariable linear regression model, lesion phenotype exhibited a divergent relationship with ICU length of stay compared with operative escalation. DAI was associated with the largest increase in ICU length of stay (estimate: +4.08 days, 95% CI: 2.82–5.33; p < 0.01). In contrast, small-volume SDH, EDH, contusions ≤ 2 cm, and isolated SAH were each associated with shorter ICU stays, with adjusted reductions ranging from approximately 1.5 to 2.1 days (all p < 0.01). Discharge Disposition: Rehabilitation and Hospice (Table 3 ) Distinct, lesion-specific trajectories were observed for post-acute disposition. DAI was strongly associated with discharge to inpatient rehabilitation (OR 2.74, 95% CI 2.49–3.01; p 2 cm) showed reduced odds of rehabilitation (OR 0.78, 95% CI 0.61–0.99; p = 0.04) and increased odds of hospice discharge (OR 1.55, 95% CI 1.15–2.10; p 8 mm) was linked to modestly higher odds of both rehabilitation (OR 1.11, 95% CI 1.07–1.14; p < 0.01) and hospice discharge (OR 1.16, 95% CI 1.10–1.22; p < 0.01), reflecting heterogeneity in post-acute trajectories following major mass lesions. DISCUSSION This national analysis of adults with isolated blunt TBI without skull fracture shows a consistent disconnect between the anatomical factors that lead to neurosurgical intervention and the physiological and contextual factors that influence long-term critical care and post-acute outcomes. Among more than 450,000 patients, focal, size-dependent hemorrhagic lesions mainly directed surgical decisions, while diffuse injury types, especially DAI, were the main predictors of ICU length of stay and rehabilitation-focused discharge. These findings empirically connect radiographic appearance to specific care areas and expand current guideline frameworks by demonstrating that the factors driving surgery differ from those shaping recovery paths and end-of-life decisions. The burden of TBI in the United States remains marked by high emergency department visits and significant long-term disability, especially among older adults and fall-related causes. 1 , 2 , 6 , 7 Modern frameworks emphasize integrated, systems-level approaches that encompass prevention, acute care, and long-term recovery. 3 , 21 In this context, our findings provide population-level evidence that clinical practice follows a lesion-specific approach for surgical escalation, while variations exist in the factors that influence ongoing resource use and functional outcomes. Structural Drivers of Operative Escalation The strong, consistent link between lesion size and the need for craniotomy for subdural and epidural hematomas reflects long-standing biomechanical and clinical observations that focal mass lesions primarily threaten outcomes through compression and herniation mechanisms. 10 , 13 , 15 The higher likelihood of surgical intervention for large SDH and EDH in this group aligns with BTF guidelines that highlight the need for quick evacuation when neurological deterioration, mass effect, or radiographic worsening occur. 8 , 9 , 14 Conversely, the significantly lower chances of craniotomy for small hemorrhages and isolated SAH emphasize the cautious approach taken with lesions unlikely to cause clinically significant intracranial pressure. Importantly, DAI showed an inverse relationship with craniotomy but a positive one with intracranial pressure (ICP) monitoring. This pattern reflects the neuropathological basis of diffuse injury, characterized by widespread axonal damage and impaired cerebral autoregulation rather than discrete, surgically treatable pathology. 11 , 12 The preference for monitoring over surgical intervention in this group suggests that clinicians see DAI as mainly a physiologic risk state, aligning with guideline-based thresholds for ICP surveillance in patients at high risk for intracranial hypertension despite lacking large focal lesions. 8 , 9 , 16 Physiologic Determinants of Critical Care Utilization The multivariable model for ICU length of stay showed a reversal of the typical operative pattern. While focal hemorrhages were associated with shorter critical care durations after adjustment, DAI was associated with the largest increase in ICU days. This result supports prior research indicating that diffuse injury types lead to longer ventilator dependence, delayed neurologic recovery, and ongoing vulnerability to secondary brain injury. 12 , 18 The positive association between delayed ICP monitor placement and extended ICU stay likely reflects clinical complexity and changing physiologic instability rather than a direct effect of monitoring itself, confirming the mixed evidence on the impact of ICP-guided management on mortality and long-term functional outcomes. 16 , 17 These results highlight a key difference in TBI care: anatomic severity determines the urgency of surgical intervention, while physiologic imbalance determines the duration and intensity of neurocritical support. This distinction has practical implications for ICU triage, staffing, and early involvement of rehabilitation services, especially in systems dealing with increasing numbers of older adults with complex neurologic recovery needs. 6 , 7 Lesion Phenotypes and Post-Acute Trajectories Disposition models further differentiated between survivable but disabling injuries and non-recoverable neurologic trajectories. DAI was strongly linked to discharge to inpatient rehabilitation and not to hospice placement, consistent with a phenotype marked by high survival but significant functional impairment that requires structured recovery pathways. 18 , 19 Conversely, large contusions were associated with higher odds of hospice discharge, indicating a trajectory toward extensive parenchymal destruction and limited recovery potential. Large SDH showed heterogeneity, with modest increases in both rehabilitation and hospice, reflecting the complex interaction between surgical salvageability, baseline vulnerability, and secondary injury. System-level and contextual factors also influenced disposition. Advanced directives, Medicare coverage, and fall-related mechanisms were independently associated with hospice placement, underscoring the combined effects of neurologic severity, age-related comorbidities, and goals-of-care considerations in end-of-life decision-making. These findings underscore the importance of integrating prognostic information from lesion morphology and physiologic status into early, patient-centered discussions about recovery expectations and care preferences. Implications for Guideline-Informed Care Pathways The BTF guidelines offer strong recommendations for operative thresholds and ICP monitoring in severe TBI. 8 , 9 Our findings indicate that these structural and physiologic criteria accurately mirror real-world escalation practices across the nation. However, the disconnect between surgical triggers and factors influencing prolonged ICU use and functional outcomes highlights a gap in current guideline frameworks, which place less focus on early stratification of recovery potential and post-acute care planning. Classification systems aimed at phenotyping TBI for targeted therapies have highlighted the heterogeneity of injury biology and recovery trajectories. 22 By empirically mapping lesion size and type to distinct domains of care, this study extends these frameworks into the operational space of trauma systems, suggesting that radiographic morphology may serve as an early, actionable marker for anticipating not only surgical need but also resource intensity and rehabilitation demand. LIMITATIONS Several limitations warrant consideration. First, the retrospective design prevents causal inference and remains vulnerable to residual confounding despite thorough covariate adjustment. Second, reliance on AIS coding and registry-derived descriptors may lead to misclassification of lesion size or shape, especially for complex or evolving injuries. Although the modified Berne–Norwood framework was used to improve clinical relevance, detailed radiographic features like volumetric measurements, millimeter-scale midline shift, and serial imaging progression were not consistently available. Third, the ACS-TQIP-PUF does not include detailed physiologic variables such as intracranial pressure values, cerebral perfusion metrics, or sedation and ventilation strategies, which may help explain variability in ICU use and outcomes. Fourth, functional outcomes beyond hospital discharge, including long-term neurologic status and quality of life, are not available in the registry, limiting the ability to assess recovery trajectories after the acute care episode. Finally, the practice patterns reflected in this dataset come from participating trauma centers and may not fully apply to non-participating or international settings. However, the size and scope of the cohort offer a strong representation of current trauma system performance in the United States. CONCLUSION In adults with isolated blunt TBI without a skull fracture, neurosurgical escalation, critical care use, and hospital discharge are guided by different but interconnected aspects of injury. Focal, size-dependent hemorrhagic lesions mainly lead to surgical intervention, while diffuse injury patterns and physiological instability, especially DAI, influence prolonged ICU stays and discharge planning focused on rehabilitation. Lesions involving extensive brain tissue are linked to transitions toward hospice care, indicating limited recovery potential and increased baseline vulnerability. These findings support a lesion-informed approach that goes beyond surgical thresholds to include early recognition of patients at risk for long-term critical illness or loss of independence. Combining radiographic morphology with physiological and contextual factors may allow for better anticipatory triage, resource allocation, and timely involvement of rehabilitation and palliative care within modern trauma systems. Declarations Meeting Presentation This work was presented as a poster series at the ACS-Critical Care Congress and the ACS-TQIP Conferences 2025. Funding Funding for this project was provided in part through philanthropic support of the Marshfield Clinic Research Institute, led by the Marshfield Clinic Health System Foundation (255800-00-RES SUPPT TRAUMA). Acknowledgment There are no conflicts of interest to share. Funding for this project was provided in part through philanthropic support of Marshfield Clinic Research Institute, led by the Marshfield Clinic Health System Foundation (255800-00-RES SUPPT TRAUMA). TQP PUF Admission 2017–2022 Version (e.g., 2020.1.0), Chicago, IL, 2025. The content reproduced from the TQP-PUF remains the full and exclusive copyrighted property of the American College of Surgeons. The American College of Surgeons is not responsible for any claims arising from works based on the original data, text, tables, or figures. References Centers for Disease Control and Prevention. Surveillance Report of Traumatic Brain Injury–related Emergency Department Visits, Hospitalizations, and Deaths, United States, 2016 and 2017. U.S. Department of Health and Human Services; 2021. Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic Brain Injury–Related Emergency Department Visits, Hospitalizations, and Deaths — United States, 2007 and 2013. MMWR Surveill Summ. 2017;66(9):1–16. 10.15585/mmwr.ss6609a1 . Maas AIR, Menon DK, Adelson PD, et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017;16(12):987–1048. 10.1016/S1474-4422(17)30371-X . Ghajar J. Traumatic brain injury. Lancet. 2000;356(9233):923–9. 10.1016/S0140-6736(00)02689-1 . Khan KA, Choudhary M, Sinha V, Gora N, Bairwa M. Predictors of outcome after traumatic brain injuries: Experience of a tertiary health care institution in Northwest India. World Neurosurg. 2019;126:e699–705. https://doi.org/10.1016/j.wneu.2019.02.126 . Gardner RC, Dams-O’Connor K, Morrissey MR, Manley GT. Geriatric traumatic brain injury: epidemiology, outcomes, knowledge gaps, and future directions. J Neurotrauma. 2018;35(7):889–906. 10.1089/neu.2017.5371 . Stocchetti N, Paternò R, Citerio G, Beretta L, Colombo A. Traumatic brain injury in an aging population. J Neurotrauma. 2012;29(6):1119–25. 10.1089/neu.2011.1995 . Carney N, Totten AM, O’Reilly C, et al. Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery. 2017;80(1):6–15. 10.1227/NEU.0000000000001432 . Brain Trauma Foundation. Guidelines for the Management of Severe Traumatic Brain Injury, 4th Edition. Brain Trauma Foundation. 2016. Available at: https://www.braintrauma.org/guidelines/guidelines-for-the-management-of-severe-tbi-4th-ed#/ Gennarelli TA, Thibault LE. Biomechanics of acute subdural hematoma. J Trauma. 1982;22(8):680–6. 10.1097/00005373-198208000-00005 . Adams JH, Graham DI, Murray LS, Scott G. Diffuse axonal injury due to nonmissile head injury in humans: an analysis of 45 cases. Ann Neurol. 1982;12(6):557–63. 10.1002/ana.410120610 . Povlishock JT, Katz DI. Update of neuropathology and neurological recovery after traumatic brain injury. J Head Trauma Rehabil. 2005;20(1):76–94. 10.1097/00001199-200501000-00008 . Wilberger JE, Harris M, Diamond DL. Acute subdural hematoma: morbidity, mortality, and operative timing. J Neurosurg. 1991;74(2):212–8. 10.3171/jns.1991.74.2.0212 . Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell D, et al. Surgical management of traumatic parenchymal lesions. Neurosurgery. 2006;58(3 Suppl):S25–46. 10.1227/01.NEU.0000210365.36914.E3 . Servadei F, Nasi MT, Giuliani G, Cremonini AM, Cenni P, Zappi D, et al. CT prognostic factors in acute subdural haematomas: The value of the worst CT scan. Br J Neurosurg. 2000;14(2):110–6. 10.1080/02688690050004525 . Badri S, Chen J, Barber J, et al. Mortality and long-term functional outcome associated with intracranial pressure after traumatic brain injury. Intensive Care Med. 2012;38(11):1800–9. 10.1007/s00134-012-2655-4 . Chesnut RM, Temkin N, Carney N, et al. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med. 2012;367(26):2471–81. 10.1056/NEJMoa1207363 . Humble S, Wilson L, Wang L, et al. Prognosis of diffuse axonal injury with traumatic brain injury. J Trauma Acute Care Surg. 2018;85(1):155–9. 10.1097/TA.0000000000001852 . Bigler ED. Neuroimaging biomarkers in mild traumatic brain injury (mTBI). Neuropsychol Rev. 2013;23(3):169–209. 10.1007/s11065-013-9237-2 . American College of Surgeons. Trauma Quality Programs Participant Use File. ACS (facs.org). Maas AIR, Menon DK, Adelson PD, et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017;16(12):987–1048. 10.1016/S1474-4422(17)30371-X . Saatman KE, Duhaime A-C, Bullock R, et al. Classification of traumatic brain injury for targeted therapies. J Neurotrauma. 2008;25(7):719–38. 10.1089/neu.2008.0586 . Association for the Advancement of Automotive Medicine. Abbreviated Injury Scale: 2015 Revision (6th ed.). Chicago, IL; 2018. Supplementary Files 08SupplementaryTable1STROBE.docx 09SupplementaryTable2AISMapping.docx 10SupplementaryTable3PatCharacteristics.docx 11SupplementaryTable4PtComorbidities.docx 12SupplementaryTable5PtInjuries.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8672720","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":581384535,"identity":"0699a694-b2c1-45c4-aa61-435a38fce914","order_by":0,"name":"Heather X Rhodes-Lyons","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAxElEQVRIiWNgGAWjYBACAwbmBhAtByIOPCBOCyNYizFYSwIpWhLBJFFazCUS2yQ+7qhLnx92+CHQFjs53QYCWix7DrZJzjxzOHfj7TQDoJZkY7MDhBx2vLFNmrftQO7G2QkgLQcStxHUcpgRpKUu3XB2+gcitUBsYU6Ql84h1pYzB5stZ7YdNtwgnVNwIMGAGL/cSD5442Nbnbz87PTNHz5U2MkR1AIELBJgvWCVBoSVgwDzBxAp30Cc6lEwCkbBKBiBAACYcEjwFYM/DwAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0001-6003-3654","institution":"Marshfield Clinic Health System","correspondingAuthor":true,"prefix":"","firstName":"Heather","middleName":"X","lastName":"Rhodes-Lyons","suffix":""},{"id":581384536,"identity":"e4e51a67-03fc-4d73-a7b5-14be800cadc1","order_by":1,"name":"David L. 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Confirm that the manuscript complies with all instructions to authors\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis manuscript fully complies with the \u003cem\u003eNeurocritical Care\u003c/em\u003e Instructions for Authors. The work adheres to the journal\u0026rsquo;s standards for original research articles, including formatting, word limits, figure and table requirements, and ethical reporting practices.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Detailed description of individual author contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors meet the authorship criteria as defined by the International Committee of Medical Journal Editors (ICMJE). Each author has made substantial contributions to the conception or design of the study, data acquisition, analysis, or interpretation; has participated in drafting or revising the manuscript for important intellectual content; has provided final approval of the version to be published; and agrees to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Confirm that authorship requirements (see below) have been met and the final manuscript was approved by all authors\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have reviewed and approved the final version of the manuscript before submission.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4. Confirm that this manuscript has not been published elsewhere and is not under consideration by another journal\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis manuscript has not been published previously in any form and is not under consideration by any other journal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5. Confirm adherence to ethical guidelines and indicate ethical approvals (IRB) and use of informed consent, as appropriate. Retrospective studies require a statement regarding IRB approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was reviewed by the Marshfield Clinic Research Institute Institutional Review Board (IRB) and determined to be exempt from oversight in accordance with federal regulations governing research with de-identified data (IRB Protocol RHO10224). The research involved a retrospective analysis of a limited, de-identified dataset; therefore, informed consent was not required. All study procedures complied with the ethical standards of the institutional and national research committees and with the principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e6. Disclose Conflicts of Interest for all authors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest relevant to this work. None of the authors has financial, professional, or personal relationships that could inappropriately influence the conduct or reporting of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e7. Confirm the use of the reporting checklist, if appropriate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cohort studies. A completed STROBE checklist is included in the supplementary material.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e8. Sources of Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunding for this project was provided in part through philanthropic support of the Marshfield Clinic Research Institute, led by the Marshfield Clinic Health System Foundation (Grant #255800-00-RES SUPPT TRAUMA). No external commercial funding was received.\u003c/p\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003eTraumatic brain injury (TBI) remains a leading cause of death and long-term disability worldwide, with an estimated 2.8\u0026nbsp;million emergency department visits, hospitalizations, and deaths each year in the United States alone.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Despite advances in neurocritical care and trauma systems, significant variability still exists in how patients with similar intracranial injury patterns are triaged, monitored, and treated across different centers.\u003csup\u003e\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e This variation is especially apparent in the growing population of adults presenting with isolated TBI without skull fracture, a population that increasingly includes an aging demographic, those with multiple health conditions, and injuries caused mostly by low-energy falls rather than high-velocity trauma.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eContemporary clinical practice in TBI is guided by a dual framework that separates surgically treatable structural lesions from diffuse or physiologic injuries that require extended neurocritical care. The Brain Trauma Foundation (BTF) guidelines highlight the importance of prompt surgical removal for focal mass lesions linked to neurological decline or radiographic signs of mass effect, while also recommending intracranial pressure (ICP) monitoring for patients at high risk of intracranial hypertension based on Glasgow Coma Scale (GCS), imaging findings, and clinical course.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e This approach reflects longstanding biomechanical and neuropathological observations that focal hematomas, such as acute subdural and epidural collections, mainly threaten outcomes through compressive and herniation-related mechanisms, whereas diffuse axonal injury (DAI) and global cerebral edema involve widespread network disruption and impaired autoregulation that are not suitable for surgical correction.\u003csup\u003e\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eEvidence supporting this conceptual separation has grown across both surgical and neurocritical care literature. Operative timing and lesion size significantly influence outcomes in acute subdural and parenchymal hematomas, underscoring size-dependent thresholds for neurosurgical intervention.\u003csup\u003e\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e In contrast, physiologic markers of secondary brain injury, including sustained intracranial hypertension and impaired cerebral perfusion, are more closely linked to longer ICU stays and long-term functional dependence.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e DAI, in particular, has become a key predictor of ongoing neurologic disability and delayed recovery, even when initial imaging shows no large focal lesions.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWhile these areas of injury biology and clinical management are often discussed separately, they are rarely studied together within a single framework that covers operative escalation, critical care use, and post-acute care decisions. Large-scale observational studies have mainly focused on mortality, neurosurgical intervention, or functional outcomes alone, rather than exploring how different injury types influence the entire care process from admission to discharge.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e This gap is becoming more important in modern trauma systems, where resource allocation, ICU capacity, and access to rehab and hospice services face increasing pressure, especially for older adults and those with significant baseline vulnerabilities.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eClassification systems like the Abbreviated Injury Scale (AIS) and modern TBI phenotyping frameworks aim to improve injury classification for targeted treatments and prognosis.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e However, these methods have not been consistently incorporated into real-world neurosurgical decision-making and neurocritical care practices. Consequently, it is still unclear whether the anatomical features that influence surgical thresholds are the same ones that cause extended physiologic instability and loss of functional independence.\u003c/p\u003e\n\u003ch3\u003eOBJECTIVE\u003c/h3\u003e\n\u003cp\u003eUsing a large, national trauma registry, we studied adults with isolated TBI without skull fracture to assess how lesion type and size, physiologic severity, and patient-level factors differently predict three important care outcomes: neurosurgical escalation, critical care use, and hospital discharge plans. We hypothesized that focal, size-dependent lesions would primarily influence surgical and monitoring decisions, whereas diffuse and physiologic injury types would more strongly affect ICU length of stay and subsequent transfers to rehabilitation or hospice. By connecting these areas within a unified framework, this study aims to clarify how well current practice follows guideline-based approaches and to identify injury profiles that might benefit from earlier, more personalized post-acute care pathways.\u003c/p\u003e"},{"header":"METHODS","content":"\u003ch2\u003eStudy Design and Data Source\u003c/h2\u003e\u003cp\u003eThis retrospective cohort study examined data from the American College of Surgeons Trauma Quality Improvement Program Participant Use File (ACS-TQIP-PUF) covering 2017 to 2022. The dataset includes de-identified patient records submitted to the National Trauma Data Bank by over 700 trauma centers across the United States, representing various facility verification levels (Level I–V and undesignated), teaching status, and ownership types.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e Informed consent was not required because the data was fully de-identified. The study was classified as exempt from full institutional review by the [RHO10224] Institutional Review Board, in line with federal regulations for secondary analysis of existing datasets. Reporting followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines (Supplementary Table\u0026nbsp;1).\u003c/p\u003e\u003ch3\u003eStudy Population and Eligibility Criteria\u003c/h3\u003e\u003cp\u003eThe analytic cohort consisted of adults aged 15 years and older who experienced an isolated blunt TBI between January 1, 2017, and December 31, 2022 (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Blunt mechanism was defined using ACS-TQIP mechanism-of-injury codes and excluded penetrating trauma. To minimize clinical variability and better attribute neurosurgical decision-making to intracranial pathology, patients with any skull fracture were excluded. Skull fractures involve distinct care pathways related to cerebrospinal fluid leakage, infection risk, and direct injury to cerebral vessels and tissue, which may independently necessitate operative or monitoring interventions.\u003c/p\u003e\u003cp\u003eTo further isolate intracranial injury burden, patients with moderate to severe extracranial trauma were excluded, defined as an AIS severity score greater than 1 in any non-head body region (Regions 2–6: face, chest, abdomen, pelvis, extremities, or external; Supplemental Table\u0026nbsp;2). This criterion limited the cohort to patients without clinically significant multisystem injury, thereby reducing confounding factors such as hemorrhagic shock, competing operative priorities, or extended critical care caused by non-neurologic organ failure. AIS coding adhered to the 2015 Revision, 6th Edition.23\u003c/p\u003e\u003ch3\u003eLesion Classification and Reference Groups\u003c/h3\u003e\u003cp\u003eTBI lesion morphology and size were classified using AIS head region codes from computed tomography scans performed within the first 24 hours of admission. Patients were grouped into mutually exclusive lesion phenotypes using a modified Berne–Norwood framework that employs clinically meaningful radiographic thresholds for mass effect and progression risk.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e Lesion subgroups included: subdural hematoma (SDH) ≤ 8 mm and \u0026gt; 8 mm, epidural hematoma (EDH) ≤ 8 mm and \u0026gt; 8 mm, cerebral contusion ≤ 2 cm and \u0026gt; 2 cm in maximum diameter, isolated subarachnoid hemorrhage (SAH), diffuse axonal injury (DAI), and subpial hemorrhage. Patients with more than one intracranial lesion type were classified as multifocal. For regression modeling, the reference group comprised patients with non-isolated SAH (N = 82,502) and those with multifocal TBI (N = 7,295), reflecting a clinically heterogeneous population in which neither focal mass lesions nor isolated diffuse injury predominated.\u003c/p\u003e\u003ch3\u003eCovariates and Variable Definitions\u003c/h3\u003e\u003cp\u003eCovariates were selected a priori based on biological plausibility and prior research linking demographic, clinical, and system-level factors to neurosurgical interventions, critical care utilization, and post-acute disposition. Variables taken from the ACS-TQIP-PUF included:\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eDemographic and Socioeconomic Factors\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eage, sex, race (African American, American Indian/Alaska Native, Asian, Caucasian, other), ethnicity (Hispanic or Latino), insurance status (Medicare, Medicaid, private/commercial, self-pay/other), trauma center verification level, teaching status, and hospital ownership (for-profit vs. non-profit).\u003c/p\u003e\u003cp\u003e \u003cstrong\u003ePrehospital and system-level features\u003c/strong\u003e \u003c/p\u003e\u003cp\u003emechanism of injury (including fall as a predefined category), mode of transport (ground ambulance, helicopter, private vehicle/other), and transfer status.\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eInjury Severity and Neurologic Status\u003c/strong\u003e \u003c/p\u003e\u003cp\u003einitial Glasgow Coma Scale score, Injury Severity Score, AIS scores by body region (head, face, chest, abdomen, pelvis, extremities, external), presence of midline shift on CT imaging, and presence of subpial hemorrhage.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003e \u003cstrong\u003eComorbid Conditions\u003c/strong\u003e \u003c/p\u003e\u003cp\u003eadvanced directive status, alcohol use disorder, anticoagulation therapy, attention deficit hyperactivity disorder, bleeding disorders, prior cerebrovascular accident, active chemotherapy, chronic obstructive pulmonary disease, cirrhosis, congestive heart failure, current smoking status, dementia, diabetes mellitus, disseminated malignancy, functional dependency, hypertension, documented mental health diagnosis, and chronic renal failure.\u003c/p\u003e\u003cp\u003e \u003cb\u003eProcedural and temporal variables\u003c/b\u003e include the performance of a craniotomy, the placement of an intracranial pressure (ICP) monitor, and the timing of ICP monitor placement, measured in hours from hospital arrival.\u003c/p\u003e\u003ch2\u003eOutcomes of Interest\u003c/h2\u003e\u003cp\u003eThe primary outcomes were neurosurgical escalation, defined as performing a craniotomy and/or placing an ICP monitor during the initial hospitalization. Secondary outcomes included intensive care unit (ICU) length of stay in days and hospital discharge disposition, categorized as rehabilitation or hospice. These outcomes were chosen to reflect three clinically distinct but related areas of care: operative decision-making, physiologic support and monitoring intensity, and post-acute recovery or end-of-life trajectory. Unlike traditional severity-based methods, this analysis explicitly stratified patients by radiographic lesion morphology and size, allowing assessment of how focal structural injury versus diffuse physiologic injury phenotypes independently influence procedural care, resource use, and subsequent disposition pathways.\u003c/p\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eDescriptive analyses were conducted to characterize the study population and lesion subgroups, with continuous variables summarized as medians and interquartile ranges and categorical variables presented as frequencies and proportions. Differences across TBI phenotypes were assessed using the Kruskal–Wallis test for continuous variables and Pearson’s chi-square test for categorical variables, as shown in Supplementary Table\u0026nbsp;3–5. Before multivariable modeling, all candidate predictors were evaluated for multicollinearity using variance inflation factors and tolerance statistics, with a tolerance threshold of \u0026gt; 0.5 to ensure model stability and proper variable independence. Variables meeting these criteria were included in the final models. Statistical significance was defined as a two-sided p-value \u0026lt; 0.05. Descriptive analyses were performed using R version 4.4.1 (R Core Team, Vienna, Austria).\u003c/p\u003e\u003cp\u003eFour main multivariable regression models were specified to match each analytic domain listed in the primary and supplementary tables.\u003c/p\u003e\u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eNeurosurgical Escalation Models\u003c/b\u003e: Two separate multivariable logistic regression models were developed to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for the relationship between lesion phenotype and (a) performing a craniotomy and (b) placing an ICP monitor (Table\u0026nbsp;1).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eCritical Care Utilization Model\u003c/b\u003e: A multivariable linear regression was constructed to identify predictors of ICU length of stay in days, including lesion subtype, timing of ICP monitor placement, demographic and system-level factors, injury severity metrics, and comorbid conditions (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eDischarge Disposition Models\u003c/b\u003e: Two multivariable logistic regression models were used to estimate adjusted ORs and 95% CIs for hospital discharge to (a) inpatient rehabilitation and (b) hospice care (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eLogistic Regression Analysis Of Factors Associated With A Craniotomy and Intracranial Monitoring\u0026nbsp;\u003c/em\u003e\u003cem\u003eAmong Adults (\u0026ge; 15 Years) That Experienced An Isolated Traumatic Brain Injury Without A Skull Fracture.\u003c/em\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"636\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 36.478%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCraniotomy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 33.9623%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIntracranial Monitoring\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e94% CI\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eLower-Upper\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e94% CI\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eLower-Upper\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eIsolated SDH \u0026le;8mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e0.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e0.32\u0026shy;\u0026ndash;0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.29\u0026ndash;0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eIsolated SDH \u0026gt;8mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e5.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e5.26\u0026ndash;5.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e2.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e1.95\u0026ndash;2.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eIsolated EDH \u0026le;8mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e0.35\u0026ndash;0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.18\u0026ndash;0.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eIsolated EDH \u0026gt;8mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e4.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e4.24\u0026ndash;5.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.91\u0026ndash;1.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eIsolated Contusion \u0026le;2cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e0.02\u0026ndash;0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.08\u0026ndash;0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eIsolated Contusion \u0026gt;2cm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e0.59\u0026ndash;1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e1.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e1.10\u0026ndash;1.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eIsolated SAH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e0.08\u0026ndash;0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.30\u0026ndash;0.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eIsolated DAI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e0.15\u0026ndash;0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e1.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e1.34\u0026ndash;1.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eSex (Male)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e1.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e1.18\u0026ndash;1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e1.34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e1.28\u0026ndash;1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eRace (Caucasian)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e0.79\u0026ndash;0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.77\u0026ndash;0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eHispanic or Latino\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e1.12\u0026ndash;1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e1.18\u0026ndash;1.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eFall Mechanism\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e1.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e1.28\u0026ndash;1.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.74\u0026ndash;0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eInsurance (Medicare)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e0.86\u0026ndash;0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.74\u0026ndash;0.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eGround Ambulance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e0.77\u0026ndash;0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.89\u0026ndash;0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eGlasgow Coma Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e0.91\u0026ndash;0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.83\u0026ndash;0.84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eComorbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eAdvanced Directive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e0.70\u0026ndash;0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0 .75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.68\u0026ndash;0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eAlcohol Use Disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e1.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e1.30\u0026ndash;1.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.94\u0026ndash;1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eAnticoagulation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e0.99\u0026ndash;1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.79\u0026ndash;0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eADHD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e0.78\u0026ndash;1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.92\u0026ndash;1.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eBleeding Disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e1.04\u0026ndash;1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.90\u0026ndash;1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eCVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e1.01\u0026ndash;1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e1.00\u0026ndash;1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eChemotherapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e0.71\u0026ndash;0.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.62\u0026ndash;0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eCOPD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e0.99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e0.94\u0026ndash;1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.84\u0026ndash;0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.02\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eCirrhosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e0.84\u0026ndash;1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.89\u0026ndash;1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eCHF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e0.93\u0026ndash;1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.94\u0026ndash;1.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eCurrent Smoker\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e1.00\u0026ndash;1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.91\u0026ndash;1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eDementia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e0.57\u0026ndash;0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.63\u0026ndash;0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e1.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e0.97\u0026ndash;1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.93\u0026ndash;1.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eDisseminating Cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e0.67\u0026ndash;0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.62\u0026ndash;0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eFDHS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e0.81\u0026ndash;0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.79\u0026ndash;0.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e1.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e1.10\u0026ndash;1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.99\u0026ndash;1.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eMental Health Diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e1.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e1.03\u0026ndash;1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e1.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.98\u0026ndash;1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 29.5597%;\"\u003e\n \u003cp\u003eRenal Failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 9.1195%;\"\u003e\n \u003cp\u003e1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16.0377%;\"\u003e\n \u003cp\u003e1.03\u0026ndash;1.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e\u0026lt;0.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e1.01\u0026ndash;1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11.3208%;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eNote:\u0026nbsp;\u003c/em\u003e\u003cem\u003eSDH=subdural hematoma, EDH=epidural hematoma, SAH=subarachnoid hemorrhage, DAI=diffuse axonal injury, AIS=abbreviated injury severity, ADHD=attention deficit hyperactivity disorder, CVA=cerebral vascular accident, COPD=chronic obstructive pulmonary disease, CHF=congestive heart failure, FDHS=functional dependent health status, ICP=intracranial pressure\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eReference Group:\u003c/em\u003e \u003cem\u003enon-isolated SAH (N=82,502) and multi-focal traumatic brain injury (N=7,295)\u003c/em\u003e\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eLinear Regression Analysis of Factors Associated With Intensive Care Unit Length Of Stay in Days Among Adults (≥ 15 Years) That Experienced An Isolated Traumatic Brain Injury Without A Skull Fracture.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEffect\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEstimate\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI Lower–Upper\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsolated SDH ≤8mm\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.75\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.99–-1.50\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsolated SDH \u0026gt;8mm\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.26\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.58–-0.06\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.11\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsolated EDH ≤8mm\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.62\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-2.62–-0.62\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsolated EDH \u0026gt;8mm\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.20\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-2.75–0.34\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.12\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsolated Contusion ≤2cm\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-2.07\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-2.69–-1.44\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsolated Contusion \u0026gt;2cm\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.30\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-2.49–1.88\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsolated SAH\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-1.51\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.75–-1.27\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsolated DAI\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.08\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.82–5.33\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICP Monitor Timing (hours)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.01–0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (Male)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.16–0.52\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRace (Caucasian)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.39\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.61–-0.17\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic or Latino\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.05\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.36–0.24\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFall Mechanism\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.43\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.66–-0.21\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsurance (Medicare)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.15\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.35–0.05\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGround Ambulance\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.05\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.26–0.15\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlasgow Coma Scale\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.43\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.46–-0.41\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidities\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdvanced Directive\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.44\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.82–-0.06\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol Use Disorder\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.23–0.86\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnticoagulation\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.11\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.33–0.10\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eADHD\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.29\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.74–1.32\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.57\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBleeding Disorder\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.18\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.42–0.78\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.55\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCVA\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.00\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.37–0.35\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChemotherapy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.13\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.97–0.70\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.75\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOPD\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.23\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.08–0.55\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCirrhosis\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.03–1.17\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHF\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.02–0.70\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent Smoker\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.04\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.30–0.20\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDementia\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.22\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.00–0.43\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisseminating Cancer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.27\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.03–0.48\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.47\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFDHS\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.00\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.25–0.26\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.11–0.27\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.40\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMental Health Diagnosis\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.05\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.31–0.21\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenal Failure\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.56\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.06–1.06\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eNote: SDH=subdural hematoma, EDH=epidural hematoma, SAH=subarachnoid hemorrhage, DAI=diffuse axonal injury, AIS=abbreviated injury severity, ADHD=attention deficit hyperactivity disorder, CVA=cerebral vascular accident, COPD=chronic obstructive pulmonary disease, CHF=congestive heart failure, FDHS=functional dependent health status, ICP=intracranial pressure, S.E.=standard error, C.I.=confidence interval\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eReference Group: non-isolated SAH (N = 82,502) and multi-focal traumatic brain injury (N = 7,295)\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cem\u003eLogistic Regression Analysis Of Factors Associated With Hospital Discharge Disposition to Rehabilitation and Hospice Among Adults (≥ 15 Years) That Experienced An Isolated Traumatic Brain Injury Without A Skull Fracture.\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eRehabilitation\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eHospice\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEffect\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94% CI\u003c/p\u003e \u003cp\u003eLower-Upper\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e94% CI\u003c/p\u003e \u003cp\u003eLower-Upper\u003c/p\u003e \u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsolated SDH ≤8mm\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.61\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.60–0.63\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.46\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.43–0.48\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsolated SDH \u0026gt;8mm\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.11\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.07–1.14\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.16\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.10–1.22\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsolated EDH ≤8mm\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.64\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.57–0.73\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.44\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.33–0.59\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsolated EDH \u0026gt;8mm\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.72–1.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.06\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.74\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.53–1.03\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.08\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsolated Contusion ≤2cm\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.53\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.49–0.58\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.34\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.28–0.43\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsolated Contusion \u0026gt;2cm\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.78\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.61–0.99\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.04\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.55\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.15–2.10\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsolated SAH\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.65\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.63–0.67\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.51\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.48–0.54\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIsolated DAI\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.74\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.49–3.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.64–1.17\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.37\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex (Male)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.06\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.04–1.08\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.04–1.12\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRace (Caucasian)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.09\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.06–1.12\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.04–1.12\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHispanic or Latino\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.72\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.69–0.75\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.37\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.29–1.45\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFall Mechanism\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.86\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.84–0.88\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.76\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.54–3.00\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsurance (Medicare)\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.33\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.30–1.36\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.60\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.58–1.74\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGround Ambulance\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.98\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.96–1.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.35\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.18\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.12–1.24\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlasgow Coma Scale\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.95–0.96\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.87\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.87–0.88\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComorbidities\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdvanced Directive\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.68\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.65–0.71\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.51\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.39–2.63\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol Use Disorder\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.14\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.10–1.18\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.62–0.75\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnticoagulation\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.05–1.10\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.17\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.12–1.22\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eADHD\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.09\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.97–1.22\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.58–1.21\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.36\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBleeding Disorder\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.98–1.12\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.14\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.27\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.14–1.40\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCVA\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.22\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.17–1.27\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.20\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.12–1.28\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChemotherapy\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.76–0.93\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.04\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.81–2.29\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCOPD\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.98–1.05\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.07\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.01–1.14\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCirrhosis\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.84–0.96\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.06\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.85–2.28\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHF\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.97\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.93–1.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.16\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.33\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.50–1.14\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent Smoker\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.85\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.82–0.87\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.73–0.85\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDementia\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.70\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.67–0.72\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2.83\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.70–2.95\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.06–1.11\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.96\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.92–1.00\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.10\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDisseminating Cancer\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.82\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.75–0.89\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.21\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2.91–3.53\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFDHS\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.28\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.25–1.32\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00–1.09\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.22\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.19–1.25\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.00–1.09\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.02\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMental Health Diagnosis\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.05–1.11\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.80\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.76–0.85\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRenal Failure\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.86–0.96\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt; 0.01\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.12\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1.02–1.23\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.01\u003c/p\u003e \u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003eNote: SDH=subdural hematoma, EDH=epidural hematoma, SAH=subarachnoid hemorrhage, DAI=diffuse axonal injury, AIS=abbreviated injury severity, ADHD=attention deficit hyperactivity disorder, CVA=cerebral vascular accident, COPD=chronic obstructive pulmonary disease, CHF=congestive heart failure, FDHS=functional dependent health status, ICP=intracranial pressure\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003eReference Group: non-isolated SAH (N = 82,502) and multi-focal traumatic brain injury (N = 7,295)\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003eAcross all models, the main independent variables were TBI lesion type and size, classified using AIS-derived morphology among patients with isolated blunt TBI without skull fracture. Covariates included age, sex, race, ethnicity, mechanism of injury, insurance status, trauma center characteristics, mode of transport, initial Glasgow Coma Scale score, Injury Severity Score, AIS scores by body region, presence of midline shift, timing of ICP monitor placement, and pre-existing comorbidities as specified above. The reference group for all regression analyses consisted of patients with non-isolated SAH (N = 82,502) and multifocal traumatic brain injury (N = 7,295), representing a clinically heterogeneous cohort in which neither focal mass lesions nor isolated diffuse injury predominated. Final multivariable models were executed using SPSS version 28 (IBM Corp., Armonk, NY).\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSection I. Descriptive Characteristics and Clinical Proportional Differences\u003c/h2\u003e \u003cp\u003eDescriptive characteristics of the study population are summarized in Supplementary Tables\u0026nbsp;3\u0026ndash;5, which detail patient demographics (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e), comorbid conditions (Table\u0026nbsp;4), and injury-related factors and clinical outcomes (Table\u0026nbsp;5) for adults with isolated blunt TBI without skull fracture. The analytic cohort included 451,754 patients, with isolated SAH being the most common lesion phenotype (35.0%), followed by SDH\u0026thinsp;\u0026le;\u0026thinsp;8 mm (30.8%), and non-isolated SAH (18.2%). Lesion subtypes associated with greater mass effect were less common, including SDH\u0026thinsp;\u0026gt;\u0026thinsp;8 mm (10.4%) and EDH\u0026thinsp;\u0026gt;\u0026thinsp;8 mm (0.3%), but showed significant differences in clinical severity and downstream care patterns.\u003c/p\u003e \u003cp\u003eThe median age across the cohort was 70 years (interquartile range [IQR] 24), with significant differences in age by lesion type (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Patients with larger SDH (\u0026gt;\u0026thinsp;8 mm) tended to be older (median 75 years, IQR 17), while those with DAI were notably younger (median 33 years, IQR 30), reflecting different injury mechanisms and baseline risks. Male patients comprised the majority (55.8%) and were disproportionately represented among those with EDH\u0026thinsp;\u0026gt;\u0026thinsp;8 mm (67.6%) and DAI (76.4%), aligning with high-energy injury mechanisms in these subgroups.\u003c/p\u003e \u003cp\u003eRacial and ethnic distributions varied significantly across lesion categories (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Caucasian patients comprised the majority of the cohort (78.4%), while insurance status reflected age and injury patterns. Medicare coverage is the most common among patients with SDH\u0026thinsp;\u0026gt;\u0026thinsp;8 mm and contusions\u0026thinsp;\u0026gt;\u0026thinsp;2 cm, and private or commercial insurance is more frequently observed in younger groups, including those with EDH and DAI.\u003c/p\u003e \u003cp\u003eThe mechanism of injury showed a clear lesion-specific pattern. Falls made up the majority of injuries in patients with SDH\u0026thinsp;\u0026gt;\u0026thinsp;8 mm (89.9%) and isolated SAH, highlighting the dominance of low-energy mechanisms in older adults. Conversely, high-energy mechanisms, such as motor vehicle and motorcycle collisions, were more common in patients with EDH and DAI, consistent with their younger age and higher rates of helicopter transport. Helicopter transport was used in 27.8% of patients with DAI and 13.2% of those with SDH\u0026thinsp;\u0026gt;\u0026thinsp;8 mm, with significantly lower rates among patients with smaller hemorrhages.\u003c/p\u003e \u003cp\u003eComorbidity burden varied significantly by lesion phenotype (Supplementary Table\u0026nbsp;4). Hypertension (54.8%) and dementia (10.7%) were common throughout the cohort, with higher rates among patients with larger SDH and contusions exceeding 2 cm. Anticoagulant use was most frequent in patients with SDH over 8 mm (33.3%) and multifocal injuries (24.7%), indicating a possible role in the development and progression of hemorrhagic lesions. Advanced directives were more common among older patients and those with high-risk hemorrhagic phenotypes, reflecting baseline vulnerability and goals-of-care considerations.\u003c/p\u003e \u003cp\u003eInjury severity metrics showed clear proportional differences across lesion subtypes (p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Patients with EDH\u0026thinsp;\u0026gt;\u0026thinsp;8 mm and SDH\u0026thinsp;\u0026gt;\u0026thinsp;8 mm had the highest Injury Severity Scores (mean 26.4 [SD 2.3] and 25.9 [SD 1.6], respectively) and maximum Head AIS scores of 5, indicating critical head injury. These patients also experienced the highest rates of neurosurgical escalation, such as craniotomy and early ICP monitoring. Conversely, patients with isolated SAH and contusions\u0026thinsp;\u0026le;\u0026thinsp;2 cm had notably lower injury severity score values (mean 7.9 [SD 4.9] and 9.5 [SD 4.0]) and Head AIS scores closer to 3, reflecting serious but not life-threatening injuries.\u003c/p\u003e \u003cp\u003eNeurologic status at presentation further differentiated lesion phenotypes. Median Glasgow Coma Scale scores were lowest among patients with DAI (median 4, IQR 5), indicating severe neurologic dysfunction and diffuse injury. Patients with SDH\u0026thinsp;\u0026gt;\u0026thinsp;8 mm also showed lower GCS scores (median 15, IQR 5), while those with small-volume hemorrhages and isolated SAH generally presented with nearly normal neurologic status.\u003c/p\u003e \u003cp\u003eClinical outcomes varied consistently by lesion size and type, providing important context for subsequent multivariable analyses. ICU length of stay was longest for patients with DAI (median 11.2 days, IQR 9.5) and SDH greater than 8 mm (median 4.4 days, IQR 3.3), compared to shorter stays in patients with isolated SAH and small contusions. Rates of ICP monitor placement and craniotomy increased progressively with lesion size, especially for SDH and EDH, while discharge to rehabilitation was most common for patients with DAI. Hospice discharge was more frequently seen among patients with large contusions and high comorbidity burden. These proportional differences highlight the clinical gradient linking lesion morphology with neurosurgical escalation, critical care needs, and downstream disposition, as examined in the adjusted regression models.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSection II: Multivariable Regression Analyses Across Surgical, Critical Care, and Disposition Domains\u003c/h2\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003eNeurosurgical Escalation: Craniotomy and ICP Monitoring (Table\u0026nbsp;1)\u003c/h2\u003e \u003cp\u003eMultivariable logistic regression demonstrated a pronounced, size-dependent association between focal hemorrhagic lesion morphology and operative intervention. Relative to the reference group, large SDH (\u0026gt;\u0026thinsp;8 mm) were associated with the highest adjusted odds of craniotomy (OR 5.44, 95% CI 5.26\u0026ndash;5.62; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), followed by large EDH (\u0026gt;\u0026thinsp;8 mm; OR 4.80, 95% CI 4.24\u0026ndash;5.44; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). In contrast, small-volume SDH (\u0026le;\u0026thinsp;8 mm) and EDH (\u0026le;\u0026thinsp;8 mm) were independently associated with substantially lower odds of craniotomy (OR 0.34, 95% CI 0.32\u0026ndash;0.35 and OR 0.43, 95% CI 0.35\u0026ndash;0.53, respectively; both p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e \u003cp\u003eAssociations with ICP monitoring showed a clear pattern. Large SDH was linked to a higher likelihood of monitor placement (OR 2.04, 95% CI 1.95\u0026ndash;2.14; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), while large EDH was not (OR 1.15, 95% CI 0.91\u0026ndash;1.46; p\u0026thinsp;=\u0026thinsp;0.22). DAI had a significant positive association with ICP monitoring (OR 1.50, 95% CI 1.34\u0026ndash;1.68; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), despite being inversely related to craniotomy (OR 0.20, 95% CI 0.15\u0026ndash;0.26; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Isolated subarachnoid hemorrhage and contusions\u0026thinsp;\u0026le;\u0026thinsp;2 cm were linked to decreased odds of both surgical intervention and monitoring.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eCritical Care Utilization: ICU Length of Stay (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/h2\u003e \u003cp\u003eIn the multivariable linear regression model, lesion phenotype exhibited a divergent relationship with ICU length of stay compared with operative escalation. DAI was associated with the largest increase in ICU length of stay (estimate: +4.08 days, 95% CI: 2.82\u0026ndash;5.33; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). In contrast, small-volume SDH, EDH, contusions\u0026thinsp;\u0026le;\u0026thinsp;2 cm, and isolated SAH were each associated with shorter ICU stays, with adjusted reductions ranging from approximately 1.5 to 2.1 days (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eDischarge Disposition: Rehabilitation and Hospice (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/h2\u003e \u003cp\u003eDistinct, lesion-specific trajectories were observed for post-acute disposition. DAI was strongly associated with discharge to inpatient rehabilitation (OR 2.74, 95% CI 2.49\u0026ndash;3.01; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and was not significantly associated with hospice placement (OR 0.87, 95% CI 0.64\u0026ndash;1.17; p\u0026thinsp;=\u0026thinsp;0.37). Large contusions (\u0026gt;\u0026thinsp;2 cm) showed reduced odds of rehabilitation (OR 0.78, 95% CI 0.61\u0026ndash;0.99; p\u0026thinsp;=\u0026thinsp;0.04) and increased odds of hospice discharge (OR 1.55, 95% CI 1.15\u0026ndash;2.10; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01). Large SDH (\u0026gt;\u0026thinsp;8 mm) was linked to modestly higher odds of both rehabilitation (OR 1.11, 95% CI 1.07\u0026ndash;1.14; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and hospice discharge (OR 1.16, 95% CI 1.10\u0026ndash;1.22; p\u0026thinsp;\u0026lt;\u0026thinsp;0.01), reflecting heterogeneity in post-acute trajectories following major mass lesions.\u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis national analysis of adults with isolated blunt TBI without skull fracture shows a consistent disconnect between the anatomical factors that lead to neurosurgical intervention and the physiological and contextual factors that influence long-term critical care and post-acute outcomes. Among more than 450,000 patients, focal, size-dependent hemorrhagic lesions mainly directed surgical decisions, while diffuse injury types, especially DAI, were the main predictors of ICU length of stay and rehabilitation-focused discharge. These findings empirically connect radiographic appearance to specific care areas and expand current guideline frameworks by demonstrating that the factors driving surgery differ from those shaping recovery paths and end-of-life decisions.\u003c/p\u003e \u003cp\u003eThe burden of TBI in the United States remains marked by high emergency department visits and significant long-term disability, especially among older adults and fall-related causes.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Modern frameworks emphasize integrated, systems-level approaches that encompass prevention, acute care, and long-term recovery.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e In this context, our findings provide population-level evidence that clinical practice follows a lesion-specific approach for surgical escalation, while variations exist in the factors that influence ongoing resource use and functional outcomes.\u003c/p\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eStructural Drivers of Operative Escalation\u003c/h2\u003e \u003cp\u003eThe strong, consistent link between lesion size and the need for craniotomy for subdural and epidural hematomas reflects long-standing biomechanical and clinical observations that focal mass lesions primarily threaten outcomes through compression and herniation mechanisms.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e The higher likelihood of surgical intervention for large SDH and EDH in this group aligns with BTF guidelines that highlight the need for quick evacuation when neurological deterioration, mass effect, or radiographic worsening occur.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Conversely, the significantly lower chances of craniotomy for small hemorrhages and isolated SAH emphasize the cautious approach taken with lesions unlikely to cause clinically significant intracranial pressure.\u003c/p\u003e \u003cp\u003eImportantly, DAI showed an inverse relationship with craniotomy but a positive one with intracranial pressure (ICP) monitoring. This pattern reflects the neuropathological basis of diffuse injury, characterized by widespread axonal damage and impaired cerebral autoregulation rather than discrete, surgically treatable pathology.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e,\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e The preference for monitoring over surgical intervention in this group suggests that clinicians see DAI as mainly a physiologic risk state, aligning with guideline-based thresholds for ICP surveillance in patients at high risk for intracranial hypertension despite lacking large focal lesions.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003ePhysiologic Determinants of Critical Care Utilization\u003c/h2\u003e \u003cp\u003eThe multivariable model for ICU length of stay showed a reversal of the typical operative pattern. While focal hemorrhages were associated with shorter critical care durations after adjustment, DAI was associated with the largest increase in ICU days. This result supports prior research indicating that diffuse injury types lead to longer ventilator dependence, delayed neurologic recovery, and ongoing vulnerability to secondary brain injury.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e The positive association between delayed ICP monitor placement and extended ICU stay likely reflects clinical complexity and changing physiologic instability rather than a direct effect of monitoring itself, confirming the mixed evidence on the impact of ICP-guided management on mortality and long-term functional outcomes.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e These results highlight a key difference in TBI care: anatomic severity determines the urgency of surgical intervention, while physiologic imbalance determines the duration and intensity of neurocritical support. This distinction has practical implications for ICU triage, staffing, and early involvement of rehabilitation services, especially in systems dealing with increasing numbers of older adults with complex neurologic recovery needs.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eLesion Phenotypes and Post-Acute Trajectories\u003c/h2\u003e \u003cp\u003eDisposition models further differentiated between survivable but disabling injuries and non-recoverable neurologic trajectories. DAI was strongly linked to discharge to inpatient rehabilitation and not to hospice placement, consistent with a phenotype marked by high survival but significant functional impairment that requires structured recovery pathways.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e Conversely, large contusions were associated with higher odds of hospice discharge, indicating a trajectory toward extensive parenchymal destruction and limited recovery potential. Large SDH showed heterogeneity, with modest increases in both rehabilitation and hospice, reflecting the complex interaction between surgical salvageability, baseline vulnerability, and secondary injury.\u003c/p\u003e \u003cp\u003eSystem-level and contextual factors also influenced disposition. Advanced directives, Medicare coverage, and fall-related mechanisms were independently associated with hospice placement, underscoring the combined effects of neurologic severity, age-related comorbidities, and goals-of-care considerations in end-of-life decision-making. These findings underscore the importance of integrating prognostic information from lesion morphology and physiologic status into early, patient-centered discussions about recovery expectations and care preferences.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eImplications for Guideline-Informed Care Pathways\u003c/h2\u003e \u003cp\u003eThe BTF guidelines offer strong recommendations for operative thresholds and ICP monitoring in severe TBI.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Our findings indicate that these structural and physiologic criteria accurately mirror real-world escalation practices across the nation. However, the disconnect between surgical triggers and factors influencing prolonged ICU use and functional outcomes highlights a gap in current guideline frameworks, which place less focus on early stratification of recovery potential and post-acute care planning. Classification systems aimed at phenotyping TBI for targeted therapies have highlighted the heterogeneity of injury biology and recovery trajectories.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e By empirically mapping lesion size and type to distinct domains of care, this study extends these frameworks into the operational space of trauma systems, suggesting that radiographic morphology may serve as an early, actionable marker for anticipating not only surgical need but also resource intensity and rehabilitation demand.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eLIMITATIONS\u003c/h2\u003e \u003cp\u003eSeveral limitations warrant consideration. First, the retrospective design prevents causal inference and remains vulnerable to residual confounding despite thorough covariate adjustment. Second, reliance on AIS coding and registry-derived descriptors may lead to misclassification of lesion size or shape, especially for complex or evolving injuries. Although the modified Berne\u0026ndash;Norwood framework was used to improve clinical relevance, detailed radiographic features like volumetric measurements, millimeter-scale midline shift, and serial imaging progression were not consistently available. Third, the ACS-TQIP-PUF does not include detailed physiologic variables such as intracranial pressure values, cerebral perfusion metrics, or sedation and ventilation strategies, which may help explain variability in ICU use and outcomes. Fourth, functional outcomes beyond hospital discharge, including long-term neurologic status and quality of life, are not available in the registry, limiting the ability to assess recovery trajectories after the acute care episode. Finally, the practice patterns reflected in this dataset come from participating trauma centers and may not fully apply to non-participating or international settings. However, the size and scope of the cohort offer a strong representation of current trauma system performance in the United States.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn adults with isolated blunt TBI without a skull fracture, neurosurgical escalation, critical care use, and hospital discharge are guided by different but interconnected aspects of injury. Focal, size-dependent hemorrhagic lesions mainly lead to surgical intervention, while diffuse injury patterns and physiological instability, especially DAI, influence prolonged ICU stays and discharge planning focused on rehabilitation. Lesions involving extensive brain tissue are linked to transitions toward hospice care, indicating limited recovery potential and increased baseline vulnerability.\u003c/p\u003e \u003cp\u003eThese findings support a lesion-informed approach that goes beyond surgical thresholds to include early recognition of patients at risk for long-term critical illness or loss of independence. Combining radiographic morphology with physiological and contextual factors may allow for better anticipatory triage, resource allocation, and timely involvement of rehabilitation and palliative care within modern trauma systems.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eMeeting Presentation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was presented as a poster series at the ACS-Critical Care Congress and the ACS-TQIP Conferences 2025.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunding for this project was provided in part through philanthropic support of the Marshfield Clinic Research Institute, led by the Marshfield Clinic Health System Foundation (255800-00-RES SUPPT TRAUMA).\u003c/p\u003e\u003ch2\u003eAcknowledgment\u003c/h2\u003e \u003cp\u003eThere are no conflicts of interest to share. Funding for this project was provided in part through philanthropic support of Marshfield Clinic Research Institute, led by the Marshfield Clinic Health System Foundation (255800-00-RES SUPPT TRAUMA). TQP PUF Admission 2017\u0026ndash;2022 Version (e.g., 2020.1.0), Chicago, IL, 2025. The content reproduced from the TQP-PUF remains the full and exclusive copyrighted property of the American College of Surgeons. The American College of Surgeons is not responsible for any claims arising from works based on the original data, text, tables, or figures.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eCenters for Disease Control and Prevention. Surveillance Report of Traumatic Brain Injury\u0026ndash;related Emergency Department Visits, Hospitalizations, and Deaths, United States, 2016 and 2017. U.S. Department of Health and Human Services; 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTaylor CA, Bell JM, Breiding MJ, Xu L. 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J Neurotrauma. 2008;25(7):719\u0026ndash;38. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1089/neu.2008.0586\u003c/span\u003e\u003cspan address=\"10.1089/neu.2008.0586\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAssociation for the Advancement of Automotive Medicine. \u003cem\u003eAbbreviated Injury Scale: 2015 Revision (6th ed.).\u003c/em\u003e Chicago, IL; 2018.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Neurocritical Care, Brain Injuries, Traumatic, Hemorrhage, Treatment Outcome","lastPublishedDoi":"10.21203/rs.3.rs-8672720/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8672720/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eIn traumatic brain injury (TBI), radiographic thresholds guide surgical decisions, while physiologic criteria determine intracranial pressure (ICP) monitoring. Whether these same features predict critical care needs and post-acute discharge outcomes remains uncertain. We studied lesion-specific and size-dependent factors that influence neurosurgical escalation, intensive care unit (ICU) length of stay, and discharge pathways in adults with isolated blunt TBI without skull fracture.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWe performed a retrospective cohort study using the American College of Surgeons Trauma Quality Improvement Program Participant Use File (2017\u0026ndash;2022). Adults aged\u0026thinsp;\u0026ge;\u0026thinsp;15 years with isolated blunt TBI and no skull fracture or moderate-to-severe extracranial injury (AIS\u0026thinsp;\u0026gt;\u0026thinsp;1 in non-head regions) were included. Lesions were classified by AIS-derived morphology and a modified Berne\u0026ndash;Norwood framework. Multivariable logistic regression estimated adjusted odds ratios (ORs) for craniotomy, ICP monitoring, and discharge to rehabilitation or hospice. Multivariable linear regression assessed predictors of ICU length of stay, adjusting for demographics, injury severity, system-level factors, and comorbidities.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAmong 451,754 patients, isolated subarachnoid hemorrhage (35.0%) and subdural hematoma (SDH)\u0026thinsp;\u0026le;\u0026thinsp;8 mm (30.8%) were most common. Large SDH (\u0026gt;\u0026thinsp;8 mm) was strongly linked to craniotomy (OR 5.44, 95% CI 5.26\u0026ndash;5.62) and ICP monitoring (OR 2.04, 95% CI 1.95\u0026ndash;2.14). Diffuse axonal injury (DAI) was inversely related to craniotomy (OR 0.20, 95% CI 0.15\u0026ndash;0.26) but positively related to ICP monitoring (OR 1.50, 95% CI 1.34\u0026ndash;1.68). DAI predicted longer ICU stays (β\u0026thinsp;+\u0026thinsp;4.08 days, 95% CI 2.82\u0026ndash;5.33), while large contusions (\u0026gt;\u0026thinsp;2 cm) were linked to discharge to hospice (OR 1.55, 95% CI 1.15\u0026ndash;2.10; all values p\u0026thinsp;\u0026lt;\u0026thinsp;0.01).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eIn isolated blunt TBI, focal, size-dependent lesions influence surgical decisions, while diffuse injury patterns impact extended ICU stays and recovery or end-of-life choices. Lesion characteristics enable early assessment of surgical needs, resource requirements, and post-acute care strategies, supporting lesion-specific neurocritical care planning.\u003c/p\u003e","manuscriptTitle":"Structural Versus Physiologic Drivers of Surgical Escalation, Critical Care Utilization, and Disposition in Isolated Traumatic Brain Injury","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-04 08:04:45","doi":"10.21203/rs.3.rs-8672720/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a20ac499-19b5-4deb-9709-41b55350ef52","owner":[],"postedDate":"February 4th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-24T19:13:35+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-04 08:04:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8672720","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8672720","identity":"rs-8672720","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}