340 Utilization of the Modified Brain Injury Guidelines in Neurosurgery to Identify and Manage Low Risk Traumatic Brain Injury Patients

INTRODUCTION: The modified brain injury guidelines (mBIG) were developed to improve care of traumatic brain injury (TBI) patients and resource utilization. METHODS: This represents a retrospective cohort study at one level one trauma center. Utilization of the mBIG began in November 2021. Patient related outcome and safety measures for patients 18 years and older meeting mBIG 1 criteria treated 18 months prior to (pre-mBIG) and after implementation (post-mBIG) were compared. Patients meeting criteria for mBIG 2 or mBIG 3 classification were excluded. In contrast to the mBIG, neurosurgery was involved in the care of all TBI patients. RESULTS: 170 patients meeting mBIG 1 criteria were included (77 pre-mBIG, 93 post-mBIG). 53 patients (57%) post-mBIG were discharged from the emergency department after a period of observation, compared to 3 (4%) pre-mBIG (p=<0.01). Patients not discharged post-mBIG were most often admitted for care of unrelated traumatic injuries (85%). Repeat neuroimaging was less frequent post-mBIG (15% vs. 62%, p=<0.01). 0 patients in either cohort needed operative neurosurgical interventions, medical therapy for intracranial hypertension, or suffered neurologic deterioration. 8 (10%) pre-mBIG patients and 4 (4%) post-mBIG patients re-presented to the emergency department within 30 days (p=0.14), of which 2 pre-mBIG and 1 post-mBIG were for a TBI related complaint (p=0.59). At re-presentation, 0 patients had radiographic injury progression, needed operative neurosurgical interventions, medical therapy for intracranial hypertension, or suffered neurologic deterioration. CONCLUSIONS: Identification of TBI patients that may be safe for a short period of observation and discharge utilizing the mBIG 1 criteria with neurosurgery oversight appears to be safe and effective. Neurosurgery involvement may help to ensure safety and promote adoption by the neurosurgical community.