A Retrospective Analysis of the Brain Injury Guidelines Applied to a Level One Trauma Center

Abstract

Background: Traumatic brain injuries (TBI) result in millions of emergency room visits annually. The brain injury guidelines (BIG) were created to provide healthcare organizations a reference for the management of TBI patients. According to the BIG, neurosurgical consults (NSC) are placed for every patient who is taking aspirin and has a TBI. For the purpose of this study, TBI is defined as having an intracranial hemorrhage (ICH) on a head computed tomography (CT). Objective: The purpose of this quality improvement project was to specifically analyze neurosurgical intervention (NSI) in those TBI patients who took aspirin (ASA) pre-injury versus NSI in those not taking ASA (or any other antiplatelet or anticoagulant). Design: This quality improvement project used a retrospective cohort analysis design. This study examined the acute management of prior TBI patients to help inform recommendations to update the BIG. Setting: Banner Desert Medical Center (BDMC), Mesa, AZ between April 25, 2017 and April 25, 2019. Participants: Inclusion criteria for this study are patients who: (a) were treated at BDMC between April 25, 2017 and April 25, 2019, (b) are 18 years of age or older, (c) have a diagnosis of diffuse or focal TBI (ICD 10 codes: S06.2 and S06.2), and (d) have an ICH identified on the initial CT scan. Results: There were 16 patients (8%) classified as BIG 3 who would have been classified as a BIG 1 if they were not taking aspirin. A total of 29 patients (14%) were classified as BIG 1, 45 (22%) were classified as BIG 2, and 117 (56.5%) were classified as BIG 3. Patients classified as BIG 1 and BIG 1 and aspirin did not undergo any NSI. Conclusion: The incidence of NSI for TBI in BIG 1 and BIG 1 and taking aspirin patients did not differ. Neither group underwent any NSI. With none of the patients in either category requiring NSI, it is recommended that further retrospective and prospective studies be performed to validate altering the BIG to the modified brain injury guidelines. Patients who are taking aspirin and meet all of the other criteria of BIG 1 are classified as BIG 1 rather than BIG 3 in the modified version.