Minor TBI (mBIG) pathway
Minor TBI (mBIG) pathway
Anticipated LOS 12-16 hours
Meets BIG-1 criteria
Normal neurologic exam (or at pre-injury baseline)
Pt has spine cleared and is able to ambulate without assistance
No other traumatic injuries that need continue evaluation or treatment. Splinted extremities are acceptable provided the pt is able to ambulate
Pt not having intractable pain/vomiting
Failure to meet even one aspect of the BIG-1 criteria
Evidence of clinical intoxication
Any anticoagulation (including Aspirin, Clopidogrel, Enoxaparin or DOACs)
Presence of skull fx, epidural hematoma, or intraventricular hemorrhage
More than trace subarachnoid hemorrhage
subdural or intraparenchymal hemorrhage > 4mm
Other injuries requiring admission
Inability to ambulate
Intractable pain/vomiting
Unstable vital signs (persistent tachycardia, tachypnea, hypotension)
6-hour observation (minimum, may go longer if warranted) in the CDU
No mandatory repeat head CT
Q2 hour neurological assessment by ED nursing. Any change in neurological exam found by ED nursing will be immediately communicated to the supervising CDU MD/APP
Attending emergency medicine/APP assessment at ~6 hours, prior to discharge from CDU
Patient must have a GCS of 15 or at their pre-injury baseline and no new abnormalities on neuro/pupillary exam for discharge
Patients that do not meet discharge criteria will be transferred to a higher level of care – Lutheran for stable patients, Denver Health for unstable patients
Disposition
Acceptable Vital signs
Normal neuro exam
Tolerating diet
Able to ambulate and perform ADL’s without assistance
Acetaminophen is first choice for pain. Avoid NSAIDs and narcotics
Deterioration in clinical condition
Development of any exclusion criteria—overead of initial CT head to BIG-2 or BIG-3 criteria
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