External retrospective validation of Brain Injury Guidelines criteria and modified guidelines for improved care value in the management of patients with low-risk neurotrauma

Restricted access

OBJECTIVE

Conventional management of patients with neurotrauma frequently consists of routine, repeat head CT at preordained intervals with ICU-level monitoring, regardless of injury severity. The Brain Injury Guidelines (BIG) are a classification tool for stratifying patients into injury severity and risk-of-progression categories based on presenting clinical and radiographic findings. In the present study, the authors aimed to validate BIG criteria at a single level 1 trauma center.

METHODS

Patients were classified according to BIG criteria and evaluated for subsequent radiographic progression or development of neurological decline. A 2-year retrospective cohort review of consecutive patients with neurotrauma (n = 590) was undertaken. The authors then developed a modified BIG algorithm for use at their institution and followed its implementation prospectively over 555 consecutive patients.

RESULTS

In the retrospective analysis, no patient in the BIG 1 category (n = 88, 14.9%) demonstrated progression or neurological decline, and 7.5% of BIG 2 patients (n = 107, 18.1%) demonstrated mild radiographic progression without any decline or need for additional neurosurgical or medical intervention, whereas 15.4% of BIG 3 patients (n = 395, 66.9%) underwent additional neurosurgical procedures. In the prospective analysis, no BIG 1 (n = 105, 18.9%) or BIG 2 (n = 48, 8.6%) patients demonstrated a clinical decline or required any further neurosurgical intervention. By contrast, 12.9% of BIG 3 patients (n = 402, 72%) required immediate neurosurgical intervention, and a further 2.0% required delayed intervention based on clinical and/or radiographic evidence of injury progression.

CONCLUSIONS

Application of the BIG criteria in a single large level 1 trauma center reliably sorted patients into appropriate risk categories that accurately guided ongoing management.

ABBREVIATIONS BIG = Brain Injury Guidelines; GCS = Glasgow Coma Scale; ICH = intracranial hemorrhage; ICP = intracranial pressure; mBIG = modified BIG; mTBI = mild traumatic brain injury.
Article Information

Contributor Notes

Correspondence Justin S. Cetas: Oregon Health & Science University, Portland, OR. cetasj@ohsu.edu.INCLUDE WHEN CITING Published online November 8, 2019; DOI: 10.3171/2019.6.JNS19584.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
Headings
References
  • 1

    Almenawer SABogza IYarascavitch BSne NFarrokhyar FMurty N: The value of scheduled repeat cranial computed tomography after mild head injury: single-center series and meta-analysis. Neurosurgery 72:56642013

    • Search Google Scholar
    • Export Citation
  • 2

    Bee TKMagnotti LJCroce MAMaish GOMinard GSchroeppel TJ: Necessity of repeat head CT and ICU monitoring in patients with minimal brain injury. J Trauma 66:101510182009

    • Search Google Scholar
    • Export Citation
  • 3

    Centers for Disease Control and Prevention: Injury Prevention & Control: Traumatic Brain Injury & Concussion (http://www.cdc.gov/traumaticbraininjury/get_the_facts.html) [Accessed August 29 2019]

    • Search Google Scholar
    • Export Citation
  • 4

    Joseph BFriese RSSadoun MAziz HKulvatunyou NPandit V: The BIG (brain injury guidelines) project: defining the management of traumatic brain injury by acute care surgeons. J Trauma Acute Care Surg 76:9659692014

    • Search Google Scholar
    • Export Citation
  • 5

    Sifri ZCLivingston DHLavery RFHomnick ATMosenthal ACMohr AM: Value of repeat cranial computed axial tomography scanning in patients with minimal head injury. Am J Surg 187:3383422004

    • Search Google Scholar
    • Export Citation
  • 6

    Smith-Bindman RLipson JMarcus RKim KPMahesh MGould R: Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer. Arch Intern Med 169:207820862009

    • Search Google Scholar
    • Export Citation
TrendMD
Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 173 173 112
Full Text Views 54 54 40
PDF Downloads 34 34 31
EPUB Downloads 0 0 0
PubMed
Google Scholar