The parkland protocol's modified berne-norwood criteria predict two tiers of risk for traumatic brain injury progression

Rachel A. Pastorek, Michael W. Cripps, Ira H. Bernstein, William W. Scott, Christopher J. Madden, Kim L. Rickert, Steven E. Wolf, Herb A. Phelan

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


As a basis for venous thromboembolism (VTE) prophylaxis after traumatic brain injury (TBI), we have previously published an algorithm known as the Parkland Protocol. Patients are classified by risk for spontaneous progression of hemorrhage with chemoprophylaxis regimens tailored to each tier. We sought to validate this schema. In our algorithm, patients with any of the following are classified "low risk" for spontaneous progression: subdural hemorrhage ≤8mm thick; epidural hemorrhage ≤8mm thick; contusions ≤20mm in diameter; a single contusion per lobe; any amount of subarachnoid hemorrhage; or any amount of intraventricular hemorrhage. Patients with any injury exceeding these are "moderate risk" for progression, and any patient receiving a monitor or craniotomy is "high risk." From February 2010 to November 2012, TBI patients were entered into a dedicated database tracking injury types and sizes, risk category at presentation, and progression on subsequent computed tomgraphies (CTs). The cohort (n=414) was classified as low risk (n=200), moderate risk (n=75), or high risk (n=139) after first CT. After repeat CT scan, radiographic progression was noted in 27% of low-risk, 53% of moderate-risk, and 58% of high-risk subjects. Omnibus analysis of variance test for differences in progression rates was highly significant (p<0.0001). Tukey's post-hoc test showed the low-risk progression rate to be significantly different than both the moderate- and high-risk arms; no difference was noted between the moderate- and high-risk arms themselves. These criteria are a valid tool for classifying TBI patients into two categories of risk for spontaneous progression. This supports tailored chemoprophylaxis regimens for each arm.

Original languageEnglish (US)
Pages (from-to)1737-1743
Number of pages7
JournalJournal of neurotrauma
Issue number20
StatePublished - Oct 15 2014
Externally publishedYes


  • TBI
  • progression
  • validation
  • venous thromboembolism

ASJC Scopus subject areas

  • Clinical Neurology


Dive into the research topics of 'The parkland protocol's modified berne-norwood criteria predict two tiers of risk for traumatic brain injury progression'. Together they form a unique fingerprint.

Cite this