Reducing Low-Value Interhospital Transfers for Mild Traumatic Brain Injury.

BACKGROUND: The modified Brain Injury Guidelines (mBIG) were developed to stratify traumatic brain injuries (TBI) and improve healthcare utilization by selectively requiring repeat imaging, ICU admission, and neurosurgical (NSG) consultation. The goal of this study is to assess safety and potential resource savings associated with the application of mBIG on interhospital patient transfers for TBI.

METHODS: Adult patients with TBI transferred to our Level I trauma center from 01/2017 to 12/2022 meeting mBIG inclusion criteria were retrospectively stratified into mBIG1, mBIG2, and mBIG3 based on initial clinicoradiological factors. At the time, our institution routinely admitted patients with TBI and intracranial hemorrhage to the ICU and obtained a repeat head CT with NSG consultation, independent of TBI severity or changes in neurological exam. The primary outcome was progression of intracranial hemorrhage (ICH) on repeat imaging and/or NSG intervention. Secondary outcomes included length of stay (LOS) and financial charges. Subgroup analysis on isolated TBI without significant extracranial injury was performed.

RESULTS: Over the 6-year study period, 289 patients were classified into mBIG1 (61; 21.1%), mBIG2 (69; 23.9%), and mBIG3 (159; 55.0%). Of mBIG1 patients, 2 (2.9%) had radiological progression to mBIG2 without clinical decline, and none required NSG intervention. Of mBIG2, 2 (3.3%) patients progressed to mBIG3 and both required NSG intervention. Over 35% of transferred patients had minor isolated TBI. For mBIG1 and mBIG2, the median hospitalization charges per patient were $152,296 and $149,550 respectively, and the median LOS was 4 and 5 days respectively with the majority downgraded from the ICU within 48 hours.

CONCLUSIONS: Clinically significant progression of ICH occurred infrequently in 1.5% of patients with mBIG1-2 injuries. Over 35% of interfacility transfers for minor isolated TBI meeting mBIG1 and 2 criteria are low-value and may potentially be safely deferred in an urban healthcare setting.