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Modified Brain Injury Guidelines (mBIG)

mBIG guidelines apply only to adult trauma patients (18 yrs and older). Pediatric trauma patients (less than 18 yrs of age) are excluded from these guidelines and neurosurgical consultation should be obtained for any intracranial hemorrhage.

Modified Brain Injury Guidelines (mBIG)


Treatment Plans:
mBIG 1:
  • Place in observation (2OBS) if isolated head injury, otherwise admit to appropriate level of care
  • Neuro checks q2 hours (if in 2OBS), otherwise neuro checks q4 hours
  • If exam stable after 6 hours in 2OBS, discharge if GCS 15
  • No Keppra, no BP goals, OK to start DVT prophylaxis if not being discharged after 6 hours
  • Follow-up with neurocritical care outpatient**

mBIG 2:

  • Admission to SDCC if isolated head injury, otherwise admit to appropriate level of care
  • Neuro checks q2 hours
  • Repeat CT-head at 6 hours, OK to start DVT prophylaxis after 24 hours from stable head CT
  • Neuro checks q4 hours after 24 hours observation
  • Keppra 7 days, no BP goals
  • Follow-up with neurocritical care outpatient**

mBIG 3:

  • Neurosurgery consultation
  • Follow-up with neurosurgery outpatient
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