Retrospective Validation of the Brain Injury Guidelines at a Single Community Institution

Area of Science:

• Trauma Surgery
• Neurosurgery
• Emergency Medicine

Background:

• Traumatic brain injury (TBI) incidence and resource use are rising.
• Brain Injury Guidelines (BIG) aim to standardize care for blunt TBI but adoption is limited.
• Validation of BIG criteria at a regional Level I trauma center was assessed.

Purpose of the Study:

• To validate the Brain Injury Guidelines (BIG) for risk stratification of isolated blunt traumatic brain injury (TBI).
• To evaluate the safety and effectiveness of BIG criteria in a Level I trauma center setting.
• To identify predictors of adverse outcomes in patients with TBI.

Main Methods:

• Retrospective review of 557 adult patients with isolated blunt TBI and positive head CT findings (2018-2019).
• Exclusion of patients requiring emergent surgery or with polytrauma.
• Stratification into BIG 1-3 categories, with analysis of neurological deterioration, neurosurgical intervention, mortality, hemorrhage progression, and length of stay.

Main Results:

• BIG criteria were applied to 557 patients (BIG 1: 30.5%, BIG 2: 19.7%, BIG 3: 49.7%).
• Overall adverse outcomes were low: neurological deterioration (5.4%), neurosurgical intervention (1.6%), mortality (3.6%).
• No BIG 1 patients required neurosurgical intervention; predictors of adverse outcomes included BIG 3 classification, age ≥75, anticoagulation, and hemorrhage progression.

Conclusions:

• The Brain Injury Guidelines (BIG) are safe and effective for risk stratification in a Level I trauma center.
• BIG 1 patients exhibit minimal risk, potentially avoiding routine admission, repeat imaging, or neurosurgical consultation.
• Wider BIG implementation may enhance efficiency and reduce resource utilization without compromising patient outcomes.