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.
Velmahos GC. Brain Injury Guidelines for Small Head Injuries. JAMA Surg. 2015;150(9):872-873. doi:10.1001/jamasurg.2015.1148