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PediBIG: Optimizing the Brain Injury Guideline for Pediatric Care
Jessica A Naiditch1, Karen Piper2, Elizabeth Tyler-Kabara1
1Dell Children's Medical Center of Central Texas, Austin, TX, USA; University of Texas - Austin Dell Medical School, Austin, TX, USA.
Insights
Revising the Brain Injury Guideline (BIG) for pediatric traumatic brain injury may reduce hospital admissions. Moving non-displaced skull fractures to BIG 1 could prevent unnecessary consultations and hospitalizations.
Area of Science:
- Pediatric Traumatic Brain Injury
- Neurosurgical Consultation Guidelines
Background:
- High incidence of traumatic brain injury hospitalizations necessitates optimized care pathways.
- Improvements in medical technology may reduce the need for neurosurgical consultation in some pediatric TBI cases.
- The Brain Injury Guideline (BIG) was developed to mitigate unnecessary hospital admissions and consultations.
Purpose of the Study:
- To evaluate the existing pediatric Brain Injury Guideline (BIG).
- To identify patient and injury characteristics associated with hospitalization and neurosurgical consultation needs.
- To refine BIG criteria for pediatric traumatic brain injury management.
Main Methods:
- Retrospective cohort study of 10 years of data from a Level 1 Trauma Center.
- Analysis of 822 pediatric patients with traumatic brain injury.
- Logistic regression modeling to examine factors influencing neurosurgical consultation.
Main Results:
- Patients were categorized into BIG 1 (no admission/consult), BIG 2 (admission, no consult), and BIG 3 (admission and consult).
- In BIG 2, only 1 child required neurosurgical intervention, and 12 showed imaging progression.
- Non-displaced skull fractures were not statistically related to the need for neurosurgical intervention (p = 0.008).
Conclusions:
- Findings support the existing Brain Injury Guideline (BIG) for pediatric TBI.
- Reclassifying non-displaced skull fractures from BIG 2 to BIG 1 could reduce unwarranted hospital admissions.
- Optimizing the BIG may improve resource allocation and patient management in pediatric neurotrauma.
Background:
The number of hospitalizations for traumatic brain injury is high with over 200,000 estimated in 2020 alone. With improvements in technology and care, some of these patients may have been able to avoid costly hospitalizations and unwarranted neurosurgical consultation. The Brain Injury Guideline (BIG) was developed in adults and re-examined in pediatrics to limit unwarranted admissions and consultations.
Methods:
Data from a retrospective cohort of patients identified from a single Level 1 Trauma Center over 10 years of time, were utilized to evaluate characteristics associated with need for hospitalization and/or neurosurgery consultation and examine the current Brain Injury Guideline for pediatrics. Relationships between patient and injury characteristics with need for neurosurgical consultation were examined using logistic regression modeling.
Results:
The 822 patients meeting inclusion were categorized post-hoc into BIG 1 (57, no need for admission or neurosurgical consult), 2 (448, need for admission, but no neurosurgical consult) and 3 (317, need for admission and neurosurgical consult). In the BIG 2 categorization, only 1 child needed neurosurgical intervention and 12 had some worsening on imaging. A number of factors investigated were statistically related to the need of the neurosurgical team, though non-displaced skull fractures were not (p = 0.008).
Conclusion:
Data presented here is consistent with previous work in the development of the Brain Injury Guideline (BIG). Moving non-displaced skull fractures from the BIG 2 categorization to BIG 1 may avoid unwarranted admissions in pediatric brain injury patients.
Level Of Evidence:
III, diagnostic test/criteria.
