Abstract：
OBJECTIVE: Brain Injury Guidelines (BIG) have been established to guide management related to TBI in adults. Here, BIG criteria were applied to pediatric TBI patients to evaluate reliability, safety, and resource utilization.
METHODS: A retrospective study was performed on all pediatric TBI patients aged 18 years or younger from January 2012 to July 2023 at a Level 1 Pediatric Trauma Center. The severity of TBI (BIG 1/2/3) was rated by review of initial cranial imaging by two independent observers. Inter-observer reliability was assessed. Predictions based on BIG criteria regarding repeat cranial imaging, ICU admission, and neurosurgical consultation were compared with observations from the cohort. Outcome data was collected, including neurosurgical intervention and mortality rate.
RESULTS: Three hundred fifty-nine patients were included with mean age of 5.3 years. Injury severity included 44 BIG 1 (12.2%), 170 BIG 2 (47.4%), and 145 BIG 3 injuries (40.4%). Inter-rater reliability was 96.4%. Neurosurgical consultation was obtained in all patients, though only predicted by guidelines in 40.4%. Repeat imaging was obtained in 166 BIG 1/2 patients, with an average of 1.3 CT scans and 0.8 MRIs/rapid MRIs per patient. ICU was utilized in 104 (77.6%) patients not recommended per BIG criteria. Ultimately, 37 patients, all BIG 3, required neurosurgical intervention; no neurosurgical interventions were required in those classified as BIG 1/2.
CONCLUSIONS: BIG criteria can be applied to pediatric TBI with high inter-observer reliability and without formal neurosurgical training. Retrospective application of BIG predicted fewer imaging studies, ICU admissions, and neurosurgical consults without overlooking patients requiring neurosurgical intervention.
METHODS: A retrospective study was performed on all pediatric TBI patients aged 18 years or younger from January 2012 to July 2023 at a Level 1 Pediatric Trauma Center. The severity of TBI (BIG 1/2/3) was rated by review of initial cranial imaging by two independent observers. Inter-observer reliability was assessed. Predictions based on BIG criteria regarding repeat cranial imaging, ICU admission, and neurosurgical consultation were compared with observations from the cohort. Outcome data was collected, including neurosurgical intervention and mortality rate.
RESULTS: Three hundred fifty-nine patients were included with mean age of 5.3 years. Injury severity included 44 BIG 1 (12.2%), 170 BIG 2 (47.4%), and 145 BIG 3 injuries (40.4%). Inter-rater reliability was 96.4%. Neurosurgical consultation was obtained in all patients, though only predicted by guidelines in 40.4%. Repeat imaging was obtained in 166 BIG 1/2 patients, with an average of 1.3 CT scans and 0.8 MRIs/rapid MRIs per patient. ICU was utilized in 104 (77.6%) patients not recommended per BIG criteria. Ultimately, 37 patients, all BIG 3, required neurosurgical intervention; no neurosurgical interventions were required in those classified as BIG 1/2.
CONCLUSIONS: BIG criteria can be applied to pediatric TBI with high inter-observer reliability and without formal neurosurgical training. Retrospective application of BIG predicted fewer imaging studies, ICU admissions, and neurosurgical consults without overlooking patients requiring neurosurgical intervention.
摘要：
目的：已经建立了脑损伤指南（BIG）来指导成人与TBI相关的管理。这里,将BIG标准应用于儿科TBI患者以评估可靠性，安全,和资源利用。
方法：2012年1月至2023年7月在一级儿科创伤中心对所有18岁或以下的儿童TBI患者进行了回顾性研究。TBI的严重程度（BIG1/2/3）由两名独立的观察者通过对初始颅骨成像的回顾来评估。评估了观察者间的可靠性。基于BIG标准的重复头颅成像预测，入住ICU,和神经外科会诊与队列观察结果进行了比较.收集了结果数据，包括神经外科干预和死亡率。
结果：纳入了三百五十九名患者，平均年龄为5.3岁。损伤严重程度包括44BIG1（12.2%），170大2（47.4%），和145大3人受伤（40.4%）。评估者间可靠性为96.4%。所有患者都获得了神经外科咨询，虽然只有40.4%的指导方针预测。在166名BIG1/2患者中获得重复成像，平均每个患者进行1.3次CT扫描和0.8次MRI/快速MRI。根据BIG标准，未推荐的104例（77.6％）患者使用了ICU。最终,37名患者,所有BIG3，需要神经外科干预；分类为BIG1/2的患者不需要神经外科干预。
结论：BIG标准可以应用于儿童TBI，具有较高的观察者间可靠性，并且无需正规的神经外科培训。BIG的回顾性应用预测了较少的影像学研究，ICU入院，和神经外科咨询，而不忽视需要神经外科干预的患者。
方法：2012年1月至2023年7月在一级儿科创伤中心对所有18岁或以下的儿童TBI患者进行了回顾性研究。TBI的严重程度（BIG1/2/3）由两名独立的观察者通过对初始颅骨成像的回顾来评估。评估了观察者间的可靠性。基于BIG标准的重复头颅成像预测，入住ICU,和神经外科会诊与队列观察结果进行了比较.收集了结果数据，包括神经外科干预和死亡率。
结果：纳入了三百五十九名患者，平均年龄为5.3岁。损伤严重程度包括44BIG1（12.2%），170大2（47.4%），和145大3人受伤（40.4%）。评估者间可靠性为96.4%。所有患者都获得了神经外科咨询，虽然只有40.4%的指导方针预测。在166名BIG1/2患者中获得重复成像，平均每个患者进行1.3次CT扫描和0.8次MRI/快速MRI。根据BIG标准，未推荐的104例（77.6％）患者使用了ICU。最终,37名患者,所有BIG3，需要神经外科干预；分类为BIG1/2的患者不需要神经外科干预。
结论：BIG标准可以应用于儿童TBI，具有较高的观察者间可靠性，并且无需正规的神经外科培训。BIG的回顾性应用预测了较少的影像学研究，ICU入院，和神经外科咨询，而不忽视需要神经外科干预的患者。
