Evidence map›Paper›PMID 41238814›Full record

ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2025

Adoption of brain injury guidelines in mild traumatic brain injury: challenges at both referring and receiving trauma centers.

Grace Hwang, Daniel Margain, Connor Fewel, Danielle Vanderet, Esther Lee, Albert Kazi, Bryan Love, Mallory Jebbia, Kevin Morrow

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Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1citing papers in PubMed
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1 · What the graph read from it

What it found

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2 · The registry

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3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

9 authors.

Grace HwangTouro University California, College of Osteopathic Medicine, Vallejo, CA, USA.
Daniel MargainDesert Regional Medical Center, Department of Trauma, Critical Care and Acute Care Surgery, Palm Springs, CA, USA.
Connor FewelDesert Regional Medical Center, Department of Trauma, Critical Care and Acute Care Surgery, Palm Springs, CA, USA.
Danielle VanderetDesert Regional Medical Center, Department of Trauma, Critical Care and Acute Care Surgery, Palm Springs, CA, USA.
Esther LeeDesert Regional Medical Center, Department of Trauma, Critical Care and Acute Care Surgery, Palm Springs, CA, USA.
Albert KaziDesert Regional Medical Center, Department of Trauma, Critical Care and Acute Care Surgery, Palm Springs, CA, USA.
Bryan LoveDesert Regional Medical Center, Department of Trauma, Critical Care and Acute Care Surgery, Palm Springs, CA, USA.
Mallory JebbiaDesert Regional Medical Center, Department of Trauma, Critical Care and Acute Care Surgery, Palm Springs, CA, USA. Mallory.jebbia@desertsurgeons.org.ORCID http://orcid.org/0000-0002-2247-5221
Kevin MorrowDepartment Neurosurgery, Desert Regional Medical Center, Palm Springs, CA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionEmerging data suggest Brain Injury Guidelines (BIG) can be used to manage patients with mild to moderate traumatic brain injury (TBI) without neurosurgical consultation. However, many Level 3 trauma centers without neurosurgical specialists continue transferring these patients to higher-level facilities. This study aimed to evaluate the transfer outcomes of TBIs and contribute to the discussion on the feasibility of observing mild TBI patients and evaluate barriers to BIG adoption at both smaller and larger hospitals.

methodsA retrospective chart review was performed on patients transferred to a Level 1 trauma center with confirmed TBI based on computed tomography (CT) between January 2018 and December 2024. Patients were assigned to BIG 1, 2, or 3. The primary outcome was need for neurosurgical intervention. Secondary outcomes included transfer times and mortality. Emergency medicine physicians at a transferring hospital were surveyed regarding obstacles to adopting BIG.

resultsA total of 301 patients were transferred to our emergency department with a TBI. Of these, 36 were BIG 1, 73 were BIG 2, and 192 were BIG 3. Neurosurgical intervention was required in 5.3% of BIG 2 patients and 18.4% in BIG 3 patients (p < 0.001), while no BIG 1 patients required intervention. Mortality was highest in BIG 3 (2.7% vs. 6.7% vs. 17.1%, p = 0.009). BIG 3 independently predicted the need for neurosurgical intervention on multivariate analysis. On survey, emergency physicians reported discomfort with use of BIG criteria without neurosurgical consultation. DISCUSSION: BIG 1 patients with mild traumatic brain injury can be safely managed without neurosurgical consultation, however adoption of BIG criteria remains limited in some areas. Our findings highlight that barriers exist at both referring and receiving hospitals including provider discomfort, medicolegal concerns, and staffing limitations at smaller centers, as well as institutional caution and conservative admission pathways at larger centers. Successful implementation will require system-wide cultural change and a staged approach, potentially beginning with retention of BIG 1 patients at smaller centers and subsequently expanding implementation as provider comfort increases.

Indexed as

Brain ConcussionGuideline AdherencePatient TransferPractice Guidelines as TopicReferral and ConsultationTrauma CentersAdultEmergency Service, HospitalFemaleHumansMaleMiddle AgedNeurosurgical ProceduresRetrospective StudiesTomography, X-Ray ComputedBrain injury guidelinesTraumaTraumatic brain injury

Identifiers

PMID41238814

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.