Page 39 - WNS 2022 Program Book-Final version

Redefining the Role of Neurosurgery in the Acute Management of Mild
TBI: the Modified Brain Injury Guidelines (mBIG) safely identifies mild
TBI patients with ICH who can discharge without neurosurgery consul-
tation.
Krista Greenan, MD, MPH UC Health Medical Group. Memorial Hospital.
Colorado Springs, CO.
Co-authors: John H. McVicker, MD, Thomas J. Schroeppel, MD, MS
Introduction: The modified Brain Injury Guideline (mBIG) uses clinical and
radiographic parameters to classify patients with mild TBI and provides an
algorithm to manage some mild TBI patients without neurosurgical consulta-
tion. Patients classified as a mBIG-1 or mBIG-2 are observed for 6 hours
(mBIG 1) or 24 hours (mBIG 2) by the trauma service and do not require
neurosurgical consultation. Patients classified as mBIG 3 require bedside
neurosurgical consultation. Any patient classified as an mBIG 1 or 2 who has
a neurological decline during the observation period is upgraded to a mBIG
3. The current study aims to further characterize the mBIG 1 and mBIG 2
patient populations and validate a model that allows management of these
patients without neurosurgical consultation.
Methods: Analysis was performed on a prospectively collected trauma data-
base. Exclusion criteria were age <15, Glasgow Coma Scale (GCS) <13, and
penetrating TBI.
Results: 880 patients were identified over the 8-year study period. 359
(40.7%) met criteria for mBIG 1 and 521 (59.2%) met criteria for mBIG 2.
Mean age was 54.9 years. The mean ISS and median GCS were 12.2 and
15, respectively. The median LOS was 2 days. The most common ICH was
SDH (54.2%) followed by SAH (50.4%). Of the entire cohort, 12% had radio-
graphic progression with no significant difference between mBIG1 and
mBIG2. 4 patients (0.45%) had readmission related to TBI from the index
admission: 1 had a new IPH that did not require a surgical intervention, 2 had
clinical changes without new CT findings, and 1 suffered stroke requiring
thrombectomy. 2 patients suffered mortality unrelated to their TBI.
Conclusions: The mBIG safely stratifies patients with mild TBI and improves
resource utilization of hospital beds and neurosurgical staff. Serial neurologi-
cal examination is a critical component to the guidelines, allowing for patients
to be safely discharged without neurosurgical consultation.

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