The Modified Brain Injury Guidelines Identify Low-Risk Traumatic Brain Injury Regardless of Age

Area of Science:

• Neurosurgery
• Trauma Surgery
• Emergency Medicine

Background:

• The modified Brain Injury Guidelines (mBIG) classify traumatic brain injuries (TBI) to guide clinical decisions.
• Age is a known TBI risk factor but is not in the mBIG system.
• Aspirin's role in TBI outcomes requires further investigation.

Purpose of the Study:

• To assess radiographic progression and neurosurgical intervention rates in geriatric vs. non-geriatric patients stratified by mBIG.
• To determine if advanced age (>65) or aspirin use impacts TBI outcomes within the mBIG classification.

Main Methods:

• Retrospective observational study of blunt TBI patients (04/01/2018 - 03/01/2024).
• Primary outcome: neurosurgical intervention. Secondary outcome: radiographic intracranial hemorrhage progression.
• Univariable logistic regression analyzed age >65 and aspirin use.

Main Results:

• 1710 patients included: 13.5% mBIG 1, 8.1% mBIG 2, 78.4% mBIG 3.
• mBIG 1: 1.1% radiographic progression, 0% neurosurgical intervention.
• mBIG 2: 6.3% radiographic progression, 0.7% neurosurgical intervention.
• Neither age >65 nor aspirin use were associated with adverse outcomes.

Conclusions:

• The mBIG classification can identify low-risk TBI patients irrespective of age.
• Advanced age and aspirin use did not correlate with increased radiographic progression or need for neurosurgical intervention in this cohort.
• mBIG stratification remains a reliable tool for managing TBI patients.