First steps toward a BIG change: A pilot study to implement the Brain Injury Guidelines across a 24-hospital system

• DOI: 10.1016/j.amjsurg.2023.07.002
• Publication Date: 2023-07-04T15:05:08Z
• Authors: Annika Bickford Kay; Samantha A. Malone; Joseph R. Bledsoe; Sarah Majercik; David S. Morris
• Keywords: Adult; Injury Severity Score; Trauma Centers; Brain Injuries; Humans; Pilot Projects; Glasgow Coma Scale; Neurosurgical Procedures; Hospitals; Retrospective Studies

The modified Brain Injury Guidelines (mBIG) support a subset of low-risk patients to be managed without repeat head computed tomography (RHCT), neurosurgical consult (NSC), or hospital transfer/admission. This pilot aimed to assess mBIG implementation at a single facility to inform future systemwide implementation.Single cohort pilot trial at a level I trauma center, December 2021-August 2022. Adult patients included if tICH meeting BIG 1 or 2 criteria. BIG 3 patients excluded.No patients required neurosurgical intervention. 72 RHCT and 83 NSC were prevented. 21 isolated BIG 1 were safely discharged home from the ED. No hospital readmissions for tICH. Protocol adherence rate was 92%.Implementation of the mBIG at a single trauma center is feasible and optimizes resource utilization. This pilot study will inform an implementation trial of the mBIG across a 24-hospital integrated health system.