A new study shows that the updated Brain Injury Guidelines (uBIG) can reduce the unnecessary costs and burden associated with transferring patients with complicated mild traumatic brain injury (TBI). In a retrospective study of patients receiving care at level I trauma centers in Canada, at least 65% of patients categorized as having the mildest form of complicated mild TBI (uBIG-1) could be safely treated at their local hospital. The paper was published today in the Journal of Neurosurgery and is available at https://thejns.org/doi/abs/10.3171/2021.10.JNS211794.
Updated in 2018, the uBIG are designed to help local clinicians assess whether the care of patients with complicated mild TBI requires transfer to a trauma center. The uBIG combine multiple variables from a physical examination and medication history to classify patients into one of three tiers ranging from uBIG-1 (the mildest form of injury) to uBIG-3 (the most severe). To determine if implementing the uBIG could reduce the need for patient transfers without affecting patient outcomes, Mr. Jean-Nicolas Tourigny of the Université Laval in Québec City, Canada, and colleagues conducted a retrospective review of 477 patients who presented or were transferred to one of three level I trauma centers in Québec.
Of the 40 patients classified with the mildest form of complicated TBI (uBIG-1), at least 65% of patients could have been treated at their local hospital without the need for transfer or a neurosurgical consultation. Additionally, 5.4% of repeat head CT scans and 4.9% of hospitalizations could have been avoided for all patients. Like all clinical guidelines, uBIG has some important limitations, principally that the guidelines do not account for additional non-head injuries sustained by the patient. Recognizing this limitation, Mr. Tourigny and colleagues concluded that uBIGs’ adoption could potentially reduce the number of transfers to centers with a higher level of trauma designation by 6% to 25%.
“Further refinement of the uBIG criteria could improve specificity and efficiency at a system level,” said Mr. Tourigny. “This is really a game changer for emergency medicine, especially now with the competing demands for health services in the era of the COVID-19 pandemic.”
AANS Neurosurgeon is the official socioeconomic publication of the American Association of Neurological Surgeons (AANS) and features information and analysis for contemporary neurosurgical practice. Published monthly online, AANS Neurosurgeon focuses on issues related to neurosurgery legislation, the workforce and practice management.
