Reducing low-value interhospital transfers for mild traumatic brain injury

Area of Science:

• Neurosurgery
• Trauma Surgery
• Health Services Research

Background:

• The modified Brain Injury Guidelines (mBIG) aim to optimize healthcare resource utilization for traumatic brain injuries (TBIs).
• Current practices often involve intensive care unit (ICU) admission and neurosurgical (NSG) consultation for interhospital TBI transfers, regardless of injury severity.
• This study evaluates the safety and economic impact of applying mBIG to interhospital TBI patient transfers.

Purpose of the Study:

• To assess the safety and potential resource savings of using the modified Brain Injury Guidelines (mBIG) for interhospital traumatic brain injury (TBI) transfers.
• To determine the rate of clinically significant intracranial hemorrhage (ICH) progression in TBI patients stratified by mBIG criteria.
• To evaluate the impact of mBIG on healthcare utilization, including ICU admission, NSG consultation, length of stay, and financial charges.

Main Methods:

• Retrospective analysis of adult TBI patients transferred to a Level I trauma center between January 2017 and December 2022.
• Patients were stratified into mBIG1, mBIG2, and mBIG3 based on initial clinicoradiological factors.
• Primary outcome: progression of ICH or need for NSG intervention. Secondary outcomes: length of stay and financial charges. Subgroup analysis for isolated TBI.

Main Results:

• 289 patients were stratified: mBIG1 (21.1%), mBIG2 (23.9%), mBIG3 (55.0%).
• Clinically significant ICH progression occurred in only 1.5% of mBIG1 and mBIG2 patients, with no NSG intervention required for mBIG1.
• Over 35% of transfers involved minor isolated TBI; mBIG1 and mBIG2 patients had significant length of stay and charges, often with early ICU downgrades.

Conclusions:

• Clinically significant intracranial hemorrhage progression is infrequent in patients with mBIG1 and mBIG2 injuries.
• A substantial proportion (over 35%) of interfacility transfers for minor isolated TBI meeting mBIG1 and mBIG2 criteria represent low-value care.
• The application of mBIG criteria may allow for the safe deferral of intensive care unit admission and neurosurgical consultation for select TBI interhospital transfers in urban healthcare settings.