Traumatic brain injury (TBI) triage tool for low-risk patients: standardizing TBI care at a Level 1 trauma center

Traumatic brain injury (TBI) remains a major healthcare burden, especially among older adults. Existing triage protocols, such as the Brain Injury Guidelines, may not be universally applicable due to institutional and implementation barriers. We evaluated the impact of a novel, evidence-based TBI triage tool-developed by a multidisciplinary team using high-risk and low-risk criteria-on hospital resource utilization at a high-volume Level 1 trauma center. The triage tool stratified patients into high-risk or low-risk pathways based on age, clinical criteria, and radiographic findings. We hypothesized that implementation would reduce intensive care unit (ICU) patient days and repeat head CT scans.

We conducted a retrospective pre-post implementation study at an American College of Surgeons-verified Level 1 trauma center. The pre-implementation group included patients retrospectively categorized as low-risk from January to November 2021. The post implementation group included patients prospectively triaged as low-risk from January 2023 to June 2024. The triage tool was created through consensus from all relevant clinical stakeholders. Patient demographics, clinical outcomes, and hospital resource use were compared using Fisher's exact test, χ², and Mann-Whitney U tests.

A total of 145 patients were included (62 pre-implementation, 83 post implementation). Groups were well matched by demographics and clinical factors. Post implementation, 188 ICU-patient-days were projected to be saved, and ICU length of stay was significantly reduced (median (IQR): 1 (0-2) vs 0 (0-0) days; p<0.001). 38 repeat CT head scans were avoided, with overall scan frequency reduced (median (IQR): 2 (2-2) vs 2 (1-2); p<0.001). There were no neurosurgical interventions, in-hospital deaths, or 30-day readmissions in either group.

Implementation of a multidisciplinary, risk-based TBI triage tool significantly reduced unnecessary ICU stays and repeat head CTs without observed adverse patient outcomes in the low-risk cohort. This approach represents a scalable, value-based model for improving TBI care and optimizing resource utilization.

Level III.