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Traumatic Brain Injury l: Introduction

Traumatic Brain Injury l: Introduction

DefinitionTraumatic brain injury, or TBI, is a disturbance of normal brain function induced by an external mechanical force, such as a direct blow to the head or a penetrating injury. It can affect both brain structure and function, producing a wide range of clinical outcomes. TBI is a heterogeneous condition, meaning its effects may differ based on the type, location, and severity of the injury.Basis of ClassificationTBI is classified based on severity, injury mechanism, or pathophysiology. In...

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Systems Analysis of the Neuroinflammatory and Hemodynamic Response to Traumatic Brain Injury

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Published on: May 27, 2022

The modified Brain Injury Guidelines: safe, sensitive, but not yet specific.

Lindsey M Freeman¹, Andrew Mecum², Michael W Cripps³

¹1Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora.

Journal of Neurosurgery

|July 4, 2025

Summary

The modified Brain Injury Guidelines (mBIG) criteria, particularly mBIG 3, demonstrate high sensitivity (99.5%) for identifying patients needing neurosurgical intervention. This study supports current guidelines regarding repeat CT imaging in lower-risk head trauma patients.

Keywords:

BIG mBIG modified Brain Injury Guidelines repeat head CT traumatic brain injury traumatic intracranial hemorrhage

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Development of an Uncomplicated Mild Traumatic Brain Injury Model Modified by Weight-Drop Method and Evidenced by Magnetic Resonance Imaging

Published on: April 11, 2025

Area of Science:

Neurosurgery
Trauma Care
Radiology

Background:

The modified Brain Injury Guidelines (mBIG) are established for managing head trauma.
Previous statistical analyses of mBIG criteria have been limited to lower-severity patient groups (mBIG 1 and mBIG 2).

Purpose of the Study:

To assess the sensitivity of mBIG criteria in predicting the need for neurosurgical intervention.
To explore associations between specific mBIG 3 radiographic findings and the requirement for surgical intervention.

Main Methods:

Retrospective review of head trauma patients at a level I trauma center (May 2020 - Dec 2023).
Exclusion of patients without intracranial hemorrhage (ICH) on initial CT or those treated at outside hospitals.
Analysis of radiographic stability/progression on repeat CT, neurosurgical intervention, length of stay, and mortality.

Main Results:

Out of 1128 patients, 69.7% were in the mBIG 3 group, with 8.6% requiring intervention.
mBIG 3 criteria showed 99.5% sensitivity for neurosurgical intervention; mBIG 2+3 criteria were 100.0% sensitive.
ICH progression correlated with intervention (p < 0.001) in mBIG 3 patients. Specific mBIG 3 radiographic criteria, except intraparenchymal hemorrhage (IPH) and subarachnoid hemorrhage (SAH), were associated with intervention in patients with Glasgow Coma Scale scores of 13-15.

Conclusions:

mBIG 3 criteria are highly sensitive (99.5%) for identifying the need for neurosurgical intervention.
Hospital admission criteria (mBIG 2+3) are 100.0% sensitive.
IPH and SAH as isolated mBIG 3 radiographic findings are weak predictors for intervention in neurologically stable patients, supporting current guidelines against routine repeat CTs in mBIG 1 and 2.