Usefulness of the Updated Brain Injury Guidelines for the Triage of Minimal Traumatic Brain Injury within a Trauma System

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INTRODUCTION: Traumatic brain injuries (TBI) are associated with significant resource use. Select minimal TBI can potentially be treated in lower-acuity settings with fewer resources. The Updated Brain Injury Guidelines (UBIG) criteria (2018) were developed to guide resource use including hospital transfers. Our study examined the usefulness of UBIG to determine appropriate triage of minimal TBI within a regional trauma system. METHODS: A trauma system registry was queried (American College of Surgeons–verified Level I trauma center and 2 verified Level III trauma centers) for adult patients (18 years or older) with an AIS-Head score greater than 0. Penetrating injuries were excluded. The study period was 2020 to 2021. The primary outcome was mortality. Secondary outcomes included progression on imaging, neurosurgical intervention, clinical deterioration, and length of stay (Table). UBIG was compared to Injury Severity Score via generalized linear models as a benchmark for predictivity capability. Statistical analysis was performed with R version 4.0.5. Table. - Validation of Updated Brain Injury Guidelines (UBIG) Results Variable UBIG1 (n = 93) UBIG2 (n = 235) UBIG3 (n = 193) p Value Age (mean, y) 53.4 ± 21.2) 61.1 ± 20.5 64.9 ± 21 <0.0001 Sex (% male) 56 (60.9%) 142 (60.4%) 111 (57.5) 0.7906 Hospital length of stay (d) 3.9 ± 4.7 4.43 ± 7.2 8.2 ± 10.6) <0.0001 Worsening subsequent imaging 1 (1.1%) 14 (6%) 26 (13.5%) 0.0004 Clinical worsening 4 (4.4%) 23 (9.8%) 46 (23.8%) <0.0001 Neurosurgical intervention 0 (0%) 7 (3%) 43 (22.3) <0.0001 Mortality 1 (1.1%) 5 (2.1%) 15 (7.8%) 0.0039 Mortality odds ratio (95% CI) ref 1.9 (0.3–37.3) 7.5 (1.5–136.7) Clinical worsening odds ratio (95% CI) ref 2.4 (0.9–8.3) 6.9 (2.7–23.4) RESULTS: A total of 521 patients were identified (93 UBIG1, 235 UBIG2, 193 UBIG3). There was a significant difference between UBIG groups for outcomes of mortality, age, length of stay, worsening imaging, clinical deterioration, and neurosurgical intervention (all p < 0.05). For study outcomes, UBIG sensitivity was 63% to 86%, specificity was 68% to 71%, and AUC was 0.67 to 0.78. An extended model incorporating demographic variables demonstrated improved sensitivity (86%) and specificity (78%) with AUC of 0.86. CONCLUSION: UBIG classification can be safely applied to the triage of trauma patients presenting with TBI. Increasing UBIG status is associated with worse outcomes. Mild TBI patients with UBIG1 without other significant injuries are appropriate for management at Level III trauma centers. Our predictive model incorporating UBIG with age, sex, ethnicity, and race suggested improved accuracy compared with the UBIG alone.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.