Implementation of the Modified Brain Injury Guidelines Might Be Feasible and Cost-Effective Even in a Nontrauma Hospital

Abstract

The modified Brain Injury Guideline (mBIG) is a framework to stratify traumatic brain injury (TBI) patients based on clinical and radiographic factors in level 1 and 2 trauma centers. Approximately 75% of all US hospitals do not carry any trauma designation yet may also benefit from these guidelines. This is the first report of applying the mBIG protocol in a community hospital without any trauma designation. All adult patients with a TBI in a single center during the years 2020-2022 were retrospectively classified into mBIG categories. Primary outcomes included neurological deterioration, progression on head CT, and surgical intervention. Additional outcomes included hospital costs incurred by mBIG 1 and mBIG 2 groups. In the 116 included patients, 35 patients (30%) would have stratified into mBIG 1, 23 (20%) into mBIG 2, and 58 (50%) into mBIG 3. No patient in mBIG 1 had a decline in neurological exam, progression on head CT, or required neurosurgical intervention. Three patients in mBIG 2 had radiographic progression and one required surgical decompression. Two patients in mBIG 3 demonstrated a neurological decline and six had radiographic progression. 20/21 patients that received surgical intervention were stratified into mBIG 3. Implementation of the mBIG protocol could have reduced cost by over $250,000 over a two-year period. The mBIG protocol can safely stratify patients in a non-trauma hospital. Since non-trauma centers tend to see more minor TBI patients, implementation may have significant cost savings, reduce unnecessary hospital/ICU resources, and transfer to a tertiary institution.