Examination of Resource Utilization and Adverse Outcomes Among Isolated Traumatic Brain Injury Patients Using Modified Brain Injury Guidelines

Abstract

Background

Mild traumatic brain injuries (TBI) are often overmanaged, resulting in an inefficient use of time and resources. The Brain Injury Guidelines was developed and subsequently improved as the modified Brain Injury Guidelines (mBIG) to help standardize TBI management. This study evaluates how adopting the mBIG criteria could improve TBI management at our institution.

Materials and Methods

This retrospective observational study included patients aged 18 to 89 admitted for isolated TBI to our Level 1 trauma center ICU between January 2021 and December 2023. Patients were categorized into 3 groups using the mBIG guidelines—mBIG 1, 2, and 3; mBIG 3 were excluded. Data were collected through the institutional trauma registry and chart review.

Results

The study included 46 mBIG 1 and 44 mBIG 2 patients, who were comparable in terms of characteristics, clinical presentation, and procedures. Both groups had similar clinical outcomes, including in-hospital complications, mortality, discharge disposition, and 30-day readmission, and utilized hospital resources. All patients had a neurosurgery consult, with 49 repeat head CTs in the mBIG 1 group and 50 in the mBIG 2 group. The total combined cost for repeat head computer tomography (RHCTs) scans, magnetic resonance imaging (MRIs), computed tomography angiography (CTAs), neurosurgical consultations, and ICU stay in both groups was $337,637.4.

Discussion

The overutilization of imaging, ICU admissions, and neurosurgeon consultations can strain institutional resources and may not benefit patients with mild TBI. By adopting the mBIG criteria, institutions can implement a more efficient and safe management strategy, allowing these valuable resources to be better allocated to more severely injured patients who require them.