First steps toward a BIG change: A pilot study to implement the Brain Injury Guidelines across a 24-hospital system
American journal of surgery
INTRODUCTION: The 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. METHODS: Single 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. RESULTS: No 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%. CONCLUSION: Implementation 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.
Kay AB, Malone SA, Bledsoe JR, Majercik S, Morris DS. First steps toward a BIG change: A pilot study to implement the Brain Injury Guidelines across a 24-hospital system [published online ahead of print, 2023 Jul 4]. Am J Surg. 2023;S0002-9610(23)00316-1. doi:10.1016/j.amjsurg.2023.07.002