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.”
