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

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.