171 Applying an Updated Brain Injury Guideline Classification to Interhospital Transfer of TBI Patients: Who Benefits Most?

INTRODUCTION: The Brain Injury Guidelines (BIG) offer a validated approach for categorizing patients with mild, moderate, and severe traumatic brain injuries. Yet, their current application has been limited to injury classification. METHODS: Patients 18 years or older with cranial trauma who transferred to our Level 1 trauma center for neurosurgical care between January 2019 and December 2023 were identified. Patients with primary acute spinal cord injury without cranial insults and those with penetrating trauma were excluded. Variables, including presentation, injury, in-hospital, and follow-up characteristics, were analyzed. RESULTS: Our study revealed that BIG 3 patients were older, frailer, and regular drinkers. Additionally, they had higher injury severity scores and showed more neurologic decline during transportation (all p<0.05). BIG 1 patients were more likely to be injured in motor vehicle collisions (33.3% vs. 26.3% vs. 23.9%, p=0.04), had fewer ICU admissions (31.5% vs. 37.6% vs. 66.6%, p<0.001), and shorter hospital stays (4.6 days vs. 3.6 vs. 8.3, p<0.001). Furthermore, imaging scans of BIG 1 and 2 patients rarely showed progression (2 vs. 6 vs. 204, p<0.001), and even in cases where there was a progression, there was no clinical decline. BIG 1 patients did experience BCVI significantly more often (16.1% vs. 6.0% vs. 9.7%, p=0.01), most likely attributable to their propensity for high-impact mechanisms of injury. CONCLUSIONS: BIG 1 and BIG 2 patients rarely require transfer, while BIG 3 patients will often require transfer. Patients with higher-grade BCVI should be considered for IHT regardless of BIG classification. Our proposed guidelines may reduce unnecessary transfers and lower healthcare costs.