Department of Surgery, Kirk Kerkorian School of Medicine at UNLV, 1701 West Charleston Blvd, Suite 490, Las Vegas, NV 89102, USA.
Department of Surgery, Kirk Kerkorian School of Medicine at UNLV, 1701 West Charleston Blvd, Suite 490, Las Vegas, NV 89102, USA.
J Pediatr Surg. 2023 Mar;58(3):552-557. doi: 10.1016/j.jpedsurg.2022.07.020. Epub 2022 Aug 1.
Brain Injury Guidelines (BIG) were developed to stratify traumatic brain injuries (TBIs) by severity to decrease unnecessary CT imaging and neurosurgical consultation in low-risk cases. This study evaluated the potential effect of a modified pediatric BIG (pBIG) algorithm would have on resource utilization.
Isolated TBIs (<18 years) were queried from our Pediatric Trauma Registry from 2017 to 2020. Injuries were classified as mild (pBIG 1), moderate (pBIG 2), or severe (pBIG 3) based on neurologic status, skull fractures, size, and the number of bleeds. Modifications from the institutional adult algorithm were upgrading <4 mm epidural hematomas to pBIG 2 and eliminating interfacility transfer as a pBIG 2 criteria. The proposed pBIG 1 and 2 care plans do not include routine repeat CTs or neurosurgical consultation.
A total of 314 children with a mean age of 4.9 years were included. Skull fractures (213, 68%) and subdural hematomas (162, 52%) were the most common injuries. 89 (28%) children had repeat head CTs (2 (7%) pBIG 1, 26 (25%) pBIG 2, 61 (34%) pBIG 3). Neurosurgical consultation was obtained in 306 (98%), with 50 (16%) requiring intervention (1 (1%) pBIG 2 and 49 (27%) pBIG 3). Following the proposed pBIG would decrease neurosurgical consults to 181 (58%) and repeat CTs to 63 (20%). Following the algorithm, 91 (29%) kids would have been admitted to a higher level of care and 45 (14.3%) to a lower level.
Implementation of our pBIG algorithm would decrease neurosurgery consults (40% reduction) and repeat head CTs (29% reduction).
颅脑损伤指南（BIG）的制定旨在根据严重程度对颅脑损伤（TBI）进行分层，以减少低风险病例中不必要的 CT 成像和神经外科会诊。本研究评估了改良小儿 BIG（pBIG）算法对资源利用的潜在影响。
从 2017 年至 2020 年，从我们的小儿创伤登记处查询了孤立性 TBI（<18 岁）。根据神经状态、颅骨骨折、大小和出血数量，将损伤分类为轻度（pBIG 1）、中度（pBIG 2）或重度（pBIG 3）。与机构成人算法的修改包括将<4mm 的硬膜外血肿升级为 pBIG 2，并消除作为 pBIG 2 标准的院内转移。拟议的 pBIG 1 和 2 护理计划不包括常规重复 CT 或神经外科会诊。
共纳入 314 名平均年龄为 4.9 岁的儿童。颅骨骨折（213 例，68%）和硬膜下血肿（162 例，52%）是最常见的损伤。89 名（28%）儿童行重复头部 CT（2 名（7%）pBIG 1，26 名（25%）pBIG 2，61 名（34%）pBIG 3）。获得神经外科会诊的有 306 名（98%），其中 50 名（16%）需要干预（1 名（1%）pBIG 2 和 49 名（27%）pBIG 3）。采用拟议的 pBIG 将使神经外科会诊减少到 181 次（58%）和重复 CT 减少到 63 次（20%）。根据该算法，91 名（29%）儿童将被收治于更高等级的护理病房，45 名（14.3%）儿童将被收治于更低等级的护理病房。
实施我们的 pBIG 算法将减少神经外科会诊（减少 40%）和重复头部 CT（减少 29%）。
