MANAGEMENT OF MILD TBI AT UTMCK: OPPORTUNITY FOR IMPROVEMENT

Objectives: The management of mild Traumatic Brain Injury (TBI) has changed recently due to the acceptance of the Modified Brain Injury Guidelines (mBIG) criteria. Multiple studies have been conducted over the past several years validating the approach. Several studies have also shown that application of the mBIG criteria decreases the healthcare costs associated with treatment of mild TBI. At the University of Tennessee Medical Center, Knoxville (UTMCK) we do not use the Brain Injury Guidelines (BIG) or the mBIG criteria and tend to use the older guidance of repeat head CT at six hour intervals and neurosurgery consultation for almost all patients. We performed a retrospective review of our mild TBI patients to assess the impact these guidelines would have on their management.

Methods: This is a retrospective review of trauma patients from 1/4/2016 to 3/29/2021 presenting to UTMCK with isolated head trauma and mild TBI (Glascow Coma Score (GCS) of 13 or greater). Subjects for the study were identified using the UTMCK trauma database which was queried for GCS ≥ 13 and International Classification of Diseases, Tenth Revision (ICD-10) code specifying isolated head trauma. Charts were reviewed for the subjects to determine relevant information.

Results: 67 subjects met the initial inclusion criteria. Of those 67 patient’s 60% (40/67) met BIG1/BIG2 criteria. Repeat head CT was obtained in 78% (31/40) of those patients and only 6% (2/31) of those showed radiological worsening. Neither of those 2 patients required neurosurgical intervention or experienced any adverse clinical outcome. They both underwent a followup repeat head CT which demonstrated stability.

Conclusion: The findings of this study support the findings reported at other institutions. While a small percentage of subjects meeting mBIG1/2 criteria show worsening on repeat CT, these findings are clinically insignificant and do not result in neurosurgical intervention nor any adverse outcome