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The management of trauma patients with traumatic brain injuries (TBIs) and intracranial hemorrhages (ICHs) is complex and challenging. The Brain Injury Guidelines (BIG) offer a framework for categorizing severity and guiding treatment of ICH. 1 However, it is unclear if individuals with a history of prior neurosurgical intervention may require early neurosurgical consultation due to a possibility of increased vulnerability to neurological deterioration after even mild TBI.