The following is a summary of “First steps toward a BIG change: A pilot study to implement the Brain Injury Guidelines across a 24-hospital system,” published in the December 2023 issue of Surgery by Kay, et al.

For a study, researchers sought to assess the implementation of the modified Brain Injury Guidelines (mBIG) at a single facility to determine its feasibility and potential impact on resource utilization in managing traumatic intracranial hemorrhage (tICH) patients.

Conducted at a level I trauma center from December 2021 to August 2022, this single-cohort pilot trial focused on adult patients meeting criteria for tICH categorized as BIG 1 or 2, excluding BIG 3 cases. Implementation outcomes were evaluated, including the need for repeat head computed tomography (RHCT), neurosurgical consult (NSC), hospital transfer/admission, protocol adherence, and patient disposition.

No neurosurgical interventions were required among the enrolled patients. Implementation of mBIG resulted in the prevention of 72 RHCT and 83 NSC instances. Notably, 21 isolated BIG 1 cases were safely discharged home from the Emergency Department (ED), and no hospital readmissions for tICH occurred. The protocol adherence rate was high, at 92%.

The findings indicated that implementing mBIG at a single trauma center is feasible and optimizes resource utilization in managing tICH patients. The pilot study provided valuable insights to inform the planning of a larger-scale implementation trial of mBIG across a 24-hospital integrated health system.

Reference: americanjournalofsurgery.com/article/S0002-9610(23)00316-1/abstract