Journal article
The BIG (brain injury guidelines) project: Defining the management of traumatic brain injury by acute care surgeons
The journal of trauma and acute care surgery, Vol.76(4), pp.965-969
04/01/2014
DOI: 10.1097/TA.0000000000000161
PMID: 24662858
Abstract
BACKGROUND It is becoming a standard practice that any positive identification of a radiographic intracranial injury requires transfer of the patient to a trauma center for observation and repeat head computed tomography (RHCT). The purpose of this study was to define guidelinesbased on each patient's history, physical examination, and initial head CT findingsregarding which patients require a period of observation, RHCT, or neurosurgical consultation.
METHODS In our retrospective cohort analysis, we reviewed the records of 3,803 blunt traumatic brain injury patients during a 4-year period. We classified patients according to neurologic examination results, use of intoxicants, anticoagulation status, and initial head CT findings. We then developed brain injury guidelines (BIG) based on the individual patient's need for observation or hospitalization, RHCT, or neurosurgical consultation.
RESULTS A total of 1,232 patients had an abnormal head CT finding. In the BIG 1 category, no patients worsened clinically or radiographically or required any intervention. BIG 2 category had radiographic worsening in 2.6% of the patients. All patients who required neurosurgical intervention (13%) were in BIG 3. There was excellent agreement between assigned BIG and verified BIG. statistic is equal to 0.98.
CONCLUSION We have proposed BIG based on patient's history, neurologic examination, and findings of initial head CT scan. These guidelines must be used as supplement to good clinical examination while managing patients with traumatic brain injury. Prospective validation of the BIG is warranted before its widespread implementation.
LEVEL OF EVIDENCE Epidemiologic study, level III.
Details
- Title: Subtitle
- The BIG (brain injury guidelines) project: Defining the management of traumatic brain injury by acute care surgeons
- Creators
- Bellal Joseph - University of ArizonaRandall S. Friese - University of ArizonaMoutamn Sadoun - University of ArizonaHassan Aziz - University of ArizonaNarong Kulvatunyou - University of ArizonaViraj Pandit - University of ArizonaJulie Wynne - University of ArizonaAndrew Tang - University of ArizonaTerence O'Keeffe - University of ArizonaPeter Rhee - University of Arizona
- Resource Type
- Journal article
- Publication Details
- The journal of trauma and acute care surgery, Vol.76(4), pp.965-969
- Publisher
- Lippincott Williams & Wilkins
- DOI
- 10.1097/TA.0000000000000161
- PMID
- 24662858
- ISSN
- 2163-0755
- eISSN
- 2163-0763
- Number of pages
- 5
- Language
- English
- Date published
- 04/01/2014
- Academic Unit
- Surgery
- Record Identifier
- 9984701654902771
Metrics
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