Shen Aricia, Mizraki Nathaniel, Maya Marcel, Torbati Sam, Lahiri Shouri, Chu Ray, Margulies Daniel R, Barmparas Galinos
From the Department of Surgery (A.S., D.M., G.B.), Division of Acute Care Surgery and Surgical Critical Care, Department of Radiology (N.M., M.M.), Department of Emergency Medicine (S.T.), Department of Neurology (S.L.), Department of Biomedical Sciences (S.L.), and Department of Neurosurgery (S.L., R.C.), Cedars-Sinai Medical Center, Los Angeles, California.
J Trauma Acute Care Surg. 2024 Jun 1;96(6):944-948. doi: 10.1097/TA.0000000000004291. Epub 2024 Mar 25.
The modified Brain Injury Guidelines (mBIG) were developed to stratify traumatic brain injuries (TBIs) and improve health care utilization by selectively requiring repeat imaging, intensive care unit admission, and neurosurgical (NSG) consultation. The goal of this study is to assess safety and potential resource savings associated with the application of mBIG on interhospital patient transfers for TBI.
Adult patients with TBI transferred to our Level I trauma center from January 2017 to December 2022 meeting mBIG inclusion criteria were retrospectively stratified into mBIG1, mBIG2, and mBIG3 based on initial clinicoradiological factors. At the time, our institution routinely admitted patients with TBI and intracranial hemorrhage (ICH) to the intensive care unit and obtained a repeat head computed tomography with NSG consultation, independent of TBI severity or changes in neurological examination. The primary outcome was progression of ICH on repeat imaging and/or NSG intervention. Secondary outcomes included length of stay and financial charges. Subgroup analysis on isolated TBI without significant extracranial injury was performed.
Over the 6-year study period, 289 patients were classified into mBIG1 (61; 21.1%), mBIG2 (69; 23.9%), and mBIG3 (159; 55.0%). Of mBIG1 patients, 2 (2.9%) had radiological progression to mBIG2 without clinical decline, and none required NSG intervention. Of mBIG2, 2 patients (3.3%) progressed to mBIG3, and both required NSG intervention. More than 35% of transferred patients had minor isolated TBI. For mBIG1 and mBIG2, the median hospitalization charges per patient were $152,296 and $149,550, respectively, and the median length of stay was 4 and 5 days, respectively, with the majority downgraded from the intensive care unit within 48 hours.
Clinically significant progression of ICH occurred infrequently in 1.5% of patients with mBIG1 and mBIG2 injuries. More than 35% of interfacility transfers for minor isolated TBI meeting mBIG1 and 2 criteria are low value and may potentially be safely deferred in an urban health care setting.
Therapeutic/Care Management; Level IV.
修订后的脑损伤指南（mBIG）旨在对创伤性脑损伤（TBI）进行分层，并通过有选择地要求重复成像、重症监护病房收治和神经外科（NSG）会诊来改善医疗资源利用。本研究的目的是评估mBIG应用于TBI患者院间转运的安全性及潜在的资源节省情况。
回顾性分析2017年1月至2022年12月间从外院转入我院一级创伤中心且符合mBIG纳入标准的成年TBI患者，根据初始临床和放射学因素将其分为mBIG1、mBIG2和mBIG3组。当时，我院常规将TBI和颅内出血（ICH）患者收入重症监护病房，并在NSG会诊后进行重复头颅计算机断层扫描，而不考虑TBI严重程度或神经学检查的变化。主要结局是重复成像时ICH的进展和/或NSG干预。次要结局包括住院时间和费用。对无明显颅外损伤的单纯TBI患者进行亚组分析。
在6年的研究期间，289例患者被分为mBIG1组（61例；21.1%）、mBIG2组（69例；23.9%）和mBIG3组（159例；55.0%）。mBIG1组中，2例（2.9%）影像学进展至mBIG2组但无临床症状恶化，均无需NSG干预。mBIG2组中，2例（3.3%）进展至mBIG3组，均需NSG干预。超过35%的转运患者为轻度单纯TBI。对于mBIG1组和mBIG2组，每位患者的住院费用中位数分别为$152,296和$149,550，住院时间中位数分别为4天和5天，大多数患者在48小时内从重症监护病房转出。
mBIG1和mBIG2损伤患者中，1.5%的患者出现具有临床意义的ICH进展。超过35%符合mBIG1和2标准的轻度单纯TBI患者院间转运价值较低，在城市医疗环境中可能可以安全推迟。
治疗/护理管理；四级。
