Impact of Modified Brain Injury Guideline Incorporating Neurosurgical Consultation on Resource Utilization and Follow-Up Care in Complicated Mild Traumatic Brain Injury.

Abstract

Based on recent guidelines, neurosurgeons are no longer routinely consulted for certain patients with acute traumatic intracranial hemorrhage. The brain injury guidelines (BIG) standardize care and optimize resource utilization but lack protocolized neurosurgical involvement for patients with complicated mild traumatic brain injury (mTBI). Because of constraints on hospital bed availability in the post-COVID era, University of Utah Health adopted a modified BIG (UteBIG) protocol that included neurosurgical consultation for all patients with complicated mTBI. We evaluated resource utilization and follow-up care before and after implementation. We conducted a retrospective review of patients with mTBI presenting with traumatic intracranial hemorrhage before (January 2016-August 2022) and after (September 2022-December 2023) implementation of UteBIG. We compared emergency department (ED) discharge rates, hospital length of stay, and follow-up care. In total, 977 patients (63.5% male, mean age 58.02 ± 20.1 years) with mTBI were analyzed. The most common (57.6%) Glasgow Coma Scale score was 15. After implementation of UteBIG, significantly more patients were discharged directly from the ED (0.3% vs 7.2%, P < .001) and discharged home posthospitalization (45.6% vs 69.2%, P < .001). Length of stay did not differ significantly (8.33 days vs 5.17 days, P = .27). Follow-up care, including receipt of TBI-related educational material (78.5% vs 83.9%, P = .06) and 3-month follow-up rate (67.4% vs 72.7%, P = .13), was not significantly different before and after implementation; however, significantly fewer patients returned to the ED with lesion expansion after implementation (6.0% vs 2.7%, P = .02). Implementation of a resource utilization-focused protocol at our trauma center incorporating neurosurgery consultation for patients with complicated mTBI led to higher rates of direct discharges from the ED and to home without compromising TBI-related follow-up care. Results demonstrate that adoption of a modified BIG protocol that includes neurosurgical collaboration can translate to more efficient patient care, while ensuring stewardship of post-TBI follow-up care.