Retrospective Validation of Brain Injury Guidelines in a Rural Level II Trauma Center

Area of Science:

• Neurosurgery
• Trauma Care
• Radiology

Background:

• Traumatic brain injury (TBI) management is evolving, prompting re-evaluation of routine transfers.
• The Brain Injury Guidelines (BIG) stratify TBI patients into BIG-1, BIG-2, and BIG-3 based on clinical deterioration risk.
• Previous validation of BIG criteria occurred at Level I and III trauma centers.

Purpose of the Study:

• To validate the Brain Injury Guidelines (BIG) criteria at a rural Level II trauma center.
• To assess the clinical applicability of BIG criteria in a diverse trauma population.
• To determine if BIG-1 and BIG-2 patients require neurosurgical intervention or transfer.

Main Methods:

• Retrospective analysis of isolated TBI patients from 2018-2022 at a rural Level II trauma center.
• Patients categorized using the Brain Injury Guidelines (BIG) criteria.
• Head CT scans reviewed by a neurosurgeon; outcomes compared to published data.

Main Results:

• 454 patients analyzed: 138 BIG-1, 51 BIG-2, 263 BIG-3.
• Progression of intracranial bleed noted in 2 BIG-1 (6%) and 2 BIG-2 (12.5%) patients.
• No BIG-1 or BIG-2 patients required neurosurgical intervention, regardless of bleed progression.

Conclusions:

• Results support the Brain Injury Guidelines (BIG) authors' recommendations.
• BIG-1 and BIG-2 patients at this rural Level II center did not necessitate repeat head CT, neurosurgery consultation, or tertiary transfer.
• The BIG criteria demonstrate utility in guiding management decisions for mild to moderate TBIs in rural settings.