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

Abstract

IntroductionThe 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. MethodsSingle 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. ResultsNo 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%. ConclusionImplementation 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.