Written by Jason Lesnick
Spoon Feed
This systematic review and meta-analysis argues that the Brain Injury Guidelines (BIG) can be used to discharge appropriate patients from the ED.
BIG if true (or adopted by your institution)
Traumatic brain injuries are common and lead to a large amount of resource utilization, often requiring transfer to level 1 trauma centers.
These authors present data that BIG can spare resources and cut costs when using the BIG to avoid low-risk transfers or hospitalizations.
When classified into BIG-1, the authors suggest discharge:
- 8 studies were analyzed for neurological deterioration, resulting in a sensitivity and specificity of 98.3%(95%CI 95.7–99.4) and 12.7%(95%CI 1.5–58.7).
- 15 studies were analyzed for ruling out need for neurosurgical intervention, sensitivity and specificity of 98.7% (95%CI 97.4–99.4) and 14.4%(95%CI 3.3–45.8).
- 14 studies were analyzed for death, sensitivity and specificity of 98.2% (95%CI 96.6–99.1) and 12.8%(95%CI 3.0–41.0).
The authors note pooled incidences of outcomes for patients classified into BIG 1 as:
- Neurologic deterioration – 0.30% (4/1330)
- Neurosurgical intervention – 0.05% (1/2142)
- Death – 0.21% (3/1397).
The number of studies included were limited due to variations in reported outcomes.
The authors report other studies estimate cost savings as much as 31% with implementation.
How will this change my practice?
The idea of adopting these guidelines within certain healthcare systems could make a big (pun intended) difference for our patients. If the risk is extremely low, our rural patients often wouldn’t want to be transferred hours from home and family to sit in a hospital (or hallway) bed for 24 hours at a level 1 trauma center just to be discharged.
Source
Brain injury guidelines for the management of traumatic brain injury: a systematic review and meta-analysis. CJEM. 2026 Oct;28(10):968-981. doi: 10.1007/s43678-026-01218-y. Epub 2026 Oct 2. PMID: 42827223.
