BIG Kids: Application of a modified brain injury guideline in a pediatric trauma center

Area of Science:

• Pediatric Traumatology
• Neurosurgery
• Emergency Medicine

Background:

• Brain Injury Guidelines (BIG) were developed to stratify traumatic brain injuries (TBIs) by severity.
• The goal is to decrease unnecessary CT imaging and neurosurgical consultation in low-risk cases.
• This study evaluated the potential effect of a modified pediatric BIG (pBIG) algorithm on resource utilization.

Purpose of the Study:

• To evaluate the impact of a modified pediatric Brain Injury Guideline (pBIG) on resource utilization.
• To assess the potential reduction in CT imaging and neurosurgical consultations for pediatric TBI cases.
• To determine the algorithm's effect on patient disposition and level of care.

Main Methods:

• Isolated TBIs in patients under 18 years were queried from a Pediatric Trauma Registry (2017-2020).
• Injuries were classified as mild (pBIG 1), moderate (pBIG 2), or severe (pBIG 3) based on neurologic status, skull fractures, size, and number of bleeds.
• Modifications included upgrading small epidural hematomas to pBIG 2 and excluding interfacility transfer as a pBIG 2 criterion; routine repeat CTs and neurosurgical consultations were excluded for pBIG 1 and 2.

Main Results:

• A total of 314 children were included, with skull fractures (68%) and subdural hematomas (52%) being most common.
• The proposed pBIG algorithm could decrease neurosurgical consults by 40% (to 181 cases) and repeat CTs by 29% (to 63 cases).
• The algorithm would have resulted in 91 (29%) children admitted to a higher level of care and 45 (14.3%) to a lower level.

Conclusions:

• Implementation of the pBIG algorithm significantly reduces neurosurgery consults and repeat head CTs.
• The modified pBIG algorithm shows potential for optimizing resource utilization in pediatric TBI management.
• This approach could lead to more appropriate allocation of healthcare resources for pediatric trauma patients.