Utilization of the Modified Brain Injury Guidelines by Neurosurgeons to Improve Traumatic Brain Injury Patient Throughput at a Level I Trauma Center: A Retrospective Observational Study.

Abstract

The modified Brain Injury Guidelines (mBIG) were developed to improve care of patients with traumatic brain injury (TBI). This study aimed to assess if utilization of mBIG by neurosurgeons would improve TBI patient throughput at a Level I trauma center, particularly for patients meeting mBIG 1 criteria. This was a retrospective observational study at a Level I trauma center. The mBIG were adopted in November 2021. Outcome and safety data for patients ≥18 years old meeting mBIG 1 criteria treated 18 months before (pre-mBIG cohort) or after (post-mBIG cohort) implementation were compared. Patients meeting criteria for mBIG 2 or mBIG 3 classification were excluded. In contrast to mBIG, neurosurgery was involved in the care of all patients. The study included 170 patients with traumatic brain injury (77 pre-mBIG, 93 post-mBIG). In the post-mBIG cohort, 53 patients (57%) were discharged from the emergency department after a period of observation versus 3 patients (4%) in the pre-mBIG cohort (P ≤ 0.01). Post-mBIG patients who were not discharged were most often admitted for care of other injuries (85%). Repeat neuroimaging was less frequent in post-mBIG patients (15% vs. 62%, P ≤ 0.01). No patients in either cohort needed operative neurosurgical interventions or medical therapy for intracranial hypertension or experienced neurological deterioration. No post-mBIG patients had radiographic injury progression. The rate of repeat emergency department presentation within 30 days was not different between cohorts (P = 0.14). The mBIG 1 criteria were safe and improved low-risk TBI patient throughput at a Level I trauma center. Neurosurgical involvement may be beneficial to the mBIG while still facilitating significant resource savings.