The Brain Injury Guidelines (BIG) classify traumatic brain injuries into three categories – BIG 1, BIG 2, and BIG 3 – based on the severity of the injury and imaging findings. Here are the key differences between these categories:
## BIG 1
– Smallest/mildest injuries
– Intracranial hemorrhage ≤ 4 mm in size
– No skull fractures
– No anticoagulation/antiplatelet therapy
– No intraventricular hemorrhage (IVH)
– Managed with 6-hour observation in the emergency department
– No planned neurosurgery consultation or repeat head CT
## BIG 2
– Moderate injuries
– Intracranial hemorrhage 4-7 mm in size
– May have non-displaced skull fractures
– No anticoagulation/antiplatelet therapy
– No IVH
– Admitted to the hospital
– No planned neurosurgery consultation or repeat head CT
## BIG 3
– Largest/most severe injuries
– Intracranial hemorrhage ≥ 8 mm in size
– May have displaced skull fractures
– May be on anticoagulation/antiplatelet therapy
– May have IVH
– Admitted to the hospital
– Mandatory neurosurgical consultation
– Repeat head CT at 6 hours
– Frequent neurological checks
The key differences lie in the size of the intracranial hemorrhage, presence of skull fractures, use of anticoagulants, and the management approach. BIG 1 patients can potentially be discharged after brief observation, BIG 2 patients require hospital admission but not necessarily neurosurgical consultation, while BIG 3 patients need the most intensive management with neurosurgical involvement and repeat imaging[1].
Citations:
[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC7264829/
[2] https://www.law-wv.com/blog/2021/february/the-3-levels-of-brain-injuries/
