The Modified Brain Injury Guidelines Identify Low-Risk Traumatic Brain Injury Regardless of Age

BackgroundThe modified Brain Injury Guidelines (mBIG) assign classification to traumatic brain injuries (TBI) to guide neurosurgical consultation, repeat imaging, and admission. While age is a known risk factor for worse outcomes after TBI, it is not included in the mBIG stratification. The authors also hypothesized that, although aspirin has been removed from the mBIG classification, aspirin use might confer additional risk. This study aimed to investigate the presence of radiographic progression or the need for neurosurgical intervention among geriatric and non-geriatric patients within the mBIG classification system.MethodsThis was a retrospective observational study of blunt TBI patients presenting to a level I trauma center from 04/01/2018 to 03/01/2024. The primary outcome was neurosurgical intervention, with a secondary outcome of radiographic intracranial hemorrhage progression on follow-up imaging. Univariable logistic regression assessed associations of age >65 and aspirin use with outcomes.ResultsOf the 1710 patients included, 1341 (78.4%) were mBIG 3, 139 (8.1%) mBIG 2, and 230 (13.5%) mBIG 1. Amongst mBIG 1, only 2/230 (1.1%) had radiographic progression and 0 received neurosurgical intervention. In mBIG 2 patients, 6/139 (6.3%) progressed and 1 (0.7%) received neurosurgical intervention. Neither age >65 nor aspirin use were associated with progression in any group.ConclusionsIn this large single-center cohort, neither advanced age nor aspirin use were associated with increased radiographic progression or adverse outcomes. Based on these findings, mBIG can be utilized to identify low-risk patients regardless of age.