Outcomes of a Modification of the Brain Injury Guidelines (BIG) on Resource Utilization and its Impact on Outcomes
Research Mentor Name
Research Mentor Email Address
Institution / Department
The Michael and Marian Ilitch Department of Surgery. Wayne State University School of Medicine
Level of Research
Brain injury guidelines (BIG) were developed to classify traumatic brain injury (TBI) patients and identify those that did not require ICU admission. Our aim was to implement our modified BIG (mBIG) in hopes of decreasing use of ICU beds for small TBI hemorrhages without compromising outcomes.
Our mBIG protocol was implemented in January 2021 at Detroit Receiving Hospital with patients classified per the Table. Concurrent and retrospective data collected included demographics, ICU admission, outcomes, head CT scans and need for neurosurgical intervention. One-way ANOVA and chi-squared analysis were used with a p-value of ≤0.05 being significant.
125 patients met inclusion criteria including 16 mBIG1, 18 mBIG2, and 91 mBIG3. mBIG3 category had lower GCS (11.0±4.5; p<0.001), higher ISS (19.4±9.2; p<0.001), longer ICU LOS (7.7±13.5 days; p=0.011) and more head CT scans(3.4±1.9; p=0.004). Overall, 67% were admitted to ICU, 7.2% to stepdown, and 25.6% to the acute care floor. Adherence to the guidelines for ICU admission was 71% with 15 mBIG1 and mBIG2 patients inappropriately admitted to the ICU and 14 mBIG3 patients admitted to acute care. Adverse outcomes were only in mBIG3 group admitted to the ICU (19 patients with neurological changes, 6 patients underwent operative intervention based on a second CT scan and 12 patients died).
Our mBIG criteria accurately identified patients WITHOUT severe TBI as well as those at high risk for progression requiring neurosurgical intervention. Adherence to guidelines will decrease resource utilization without causing harm.
Analytical, Diagnostic and Therapeutic Techniques and Equipment | Medicine and Health Sciences
Getzinger, Jay; Karadjoff, Alison DO; Pitogo, Alita; and Tarras, Samantha MD FACS, "Outcomes of a Modification of the Brain Injury Guidelines (BIG) on Resource Utilization and its Impact on Outcomes" (2023). Medical Student Research Symposium. 243.