Regional modified Brain Injury Guidelines (BIG) – for adults ≥ 15 years old

The modified BIG framework for the Northern Region helps determine if a repeat CT Head is recommended for mild and moderate brain injuries as identified by the following parameters.  The patient is discharged if/when clinically appropriate as per local protocols/pathways.

Notes:

1. This is a clinical classification, not radiological. The classification needs to be determined by ED/Trauma doctor, not Radiologist. The role of Radiologist is to accurately measure the size and number of the lesions.
2. If there are multiple lesions, the largest lesion will determine BIG classification, immaterial of the type of bleed.
3. The classification is only for acute bleeds.
4. * Pertains to non-aneurysmal SAH. If history of trauma is unclear or if concerned for aneurysmal bleed, exit pathway.
5. ** Regional pathways available for reference:
   • TBI Toolkit Flowchart.
   • Guideline: Assessment & Management of Adult Patients with Moderate Traumatic Brain Injury