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Home > Emergency Medical Minute > Episode 980: Brain Injury Guidelines (BIG)
Podcast: Emergency Medical Minute
Episode:

Episode 980: Brain Injury Guidelines (BIG)
Category: Science & Medicine
Duration: 00:03:17
Publish Date: 2025-10-27 10:00:00
Description:

Contributor: Aaron Lessen, MD

Educational Pearls:

Traumatic Brain Injuries are a frequent complaint in the Emergency Department and have increased in recent years. The American Association for Surgery of Trauma (AAST) has created Brain Injury Guidelines (BIG), in an attempt to categorize brain injuries and the level of treatment they require. They are…

BIG 1

  • Normal neuro exam
  • Not intoxicated
  • Not on anticoagulation or antiplatelet medications
  • Minimal findings on head CT
    • No fracture
    • 8 mm bleed (subdural, epidural, intraparenchymal (or more than 2 locations))
    • “Scattered” subarachnoid hemorrhage
    • Intraventricular hemorrhage    
  • Full treatment, admission to trauma center, neurosurgery evaluation

References

  1. Joseph B, Friese RS, Sadoun M, Aziz H, Kulvatunyou N, Pandit V, Wynne J, Tang A, O'Keeffe T, Rhee P. The BIG (brain injury guidelines) project: defining the management of traumatic brain injury by acute care surgeons. J Trauma Acute Care Surg. 2014 Apr;76(4):965-9. doi: 10.1097/TA.0000000000000161. PMID: 24662858.
  2. Joseph B, Obaid O, Dultz L, Black G, Campbell M, Berndtson AE, Costantini T, Kerwin A, Skarupa D, Burruss S, Delgado L, Gomez M, Mederos DR, Winfield R, Cullinane D; AAST BIG Multi-institutional Study Group. Validating the Brain Injury Guidelines: Results of an American Association for the Surgery of Trauma prospective multi-institutional trial. J Trauma Acute Care Surg. 2022 Aug 1;93(2):157-165. doi: 10.1097/TA.0000000000003554. Epub 2022 Mar 28. PMID: 35343931.

Summarized by Jeffrey Olson, MS4 | Edited by Jeffrey Olson and Jorge Chalit, OMS4

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