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Invited Commentary
September 2015

Brain Injury Guidelines for Small Head Injuries

Author Affiliations
  • 1Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston
  • 2Harvard Medical School, Boston, Massachusetts
JAMA Surg. 2015;150(9):872-873. doi:10.1001/jamasurg.2015.1148

In the Joseph et al article,1 the authors proposed locally produced Brain Injury Guidelines (BIG), which allowed the acute care surgery team to manage patients with mild head injuries without neurosurgical consultation. All moderate and severe head injuries were managed per routine. The decision to avoid calling the neurosurgeon for patients with intact neurologic examinations and either no (BIG 1) or minimal (BIG 2) space-occupying lesions on computed tomography (CT) predictably produced what we know to be true. There were fewer repeated head CT scans, shorter hospital stays, and reduced hospitalization costs.

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