UMEM Educational Pearls

Category: Trauma

Title: Modified Brian Injury Guidelines and Transfers

Keywords: BIG, transfer, head trauma, brain injury (PubMed Search)

Posted: 6/9/2024 by Robert Flint, MD (Updated: 6/15/2024)
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This study used the modified Brain injury Guidelines retrospectively to assess whether the guidelines would have saved transfers to their level one facility safely.  They concluded the guidelines would have effectively prevented unnecessary  mBIG 1 and mBIG2 transfers with no patient harm.

TABLE 1 - Modified Brain Injury Guidelines Radiologic Stratification, as per Kahn et al.

  mBIG 1 mBIG 2 mBIG 3
Skull fracture No Non-displaced Displaced
SDH ?4 mm 4–7.9 mm ?8 mm
EDH No No Yes
SAH ?3 sulci and <1 mm Single hemisphere or 1–3 mm Bihemisphere or >3 mm
IVH No No Yes
IPH ?4 mm 4–7.9 mm ?8 mm or multiple

EDH, epidural hematoma; IPH, intraparenchymal hemorrhage; IVH, intraventricular hemorrhage; SAH, subarachnoid hemorrhage.


Shen, Aricia MD; Mizraki, Nathaniel MD; Maya, Marcel MD; Torbati, Sam MD; Lahiri, Shouri MD; Chu, Ray MD; Margulies, Daniel R. MD; Barmparas, Galinos MD. Reducing low-value interhospital transfers for mild traumatic brain injury. Journal of Trauma and Acute Care Surgery 96(6):p 944-948, June 2024. | DOI: 10.1097/TA.0000000000004291