cliot (version 1.0.0)

mbig_score: Modified Brain Injury Guidelines (mBIG) for TBI

Description

Classifies patients with Traumatic Brain Injury (TBI) and intracranial hemorrhage into three risk categories (mBIG 1, 2, or 3) to guide resource utilization, including the need for neurosurgical consultation, repeat imaging, and hospitalization. This modified version (Khan et al., 2020) updates the original BIG criteria for improved safety and reproducibility.

Usage

mbig_score(gcs, focal_neuro_deficit, anti_coagulation, intoxication,
           skull_fracture_type, epidural_hematoma, subdural_hematoma_mm,
           intraparenchymal_hemorrhage_mm, subarachnoid_hemorrhage_type,
           intraventricular_hemorrhage)

Value

A list containing:

mBIG_Category

The assigned risk category (mBIG 1, 2, or 3).

Management_Plan

Recommendations for admission, imaging, and consultation.

Arguments

gcs

Numeric. Glasgow Coma Scale score (3-15).

focal_neuro_deficit

Numeric (0 or 1). Presence of focal neurological findings or pupillary asymmetry. (1 = Yes).

anti_coagulation

Numeric (0 or 1). Use of anticoagulants or antiplatelets (excluding aspirin 81mg in some protocols, but often any agents). (1 = Yes).

intoxication

Numeric (0 or 1). Alcohol or drug intoxication present (e.g., EtOH > 80 mg/dL). (1 = Yes).

skull_fracture_type

String. "none", "non_displaced", or "displaced".

epidural_hematoma

Numeric (0 or 1). Presence of Epidural Hematoma (EDH). (1 = Yes). Note: Any EDH places patient in mBIG 3.

subdural_hematoma_mm

Numeric. Size of Subdural Hematoma (SDH) in millimeters. (<4mm: mBIG 1, 4-7.9mm: mBIG 2, >=8mm: mBIG 3).

intraparenchymal_hemorrhage_mm

Numeric. Size of Intraparenchymal Hemorrhage (IPH) in millimeters. (<4mm: mBIG 1, 4-7.9mm: mBIG 2, >=8mm: mBIG 3).

subarachnoid_hemorrhage_type

String. Extent of Subarachnoid Hemorrhage (SAH). "none": No SAH. "trace": <= 3 sulci and < 1 mm. "localized": 1 hemisphere or 1-3 mm. "extensive": Bi-hemispheric or > 3 mm.

intraventricular_hemorrhage

Numeric (0 or 1). Presence of Intraventricular Hemorrhage (IVH). (1 = Yes).

References

Khan AD, Elseth AJ, Brosius JA, et al. Multicenter assessment of the Brain Injury Guidelines and a proposal of guideline modifications. Trauma Surg Acute Care Open. 2020;5(1):e000483. doi:10.1136/tsaco-2020-000483

Examples

# Example 1: Low Risk (mBIG 1)
# GCS 15, Small SDH (3mm), No other findings
mbig_score(15, 0, 0, 0, "none", 0, 3, 0, "none", 0)

# Example 2: Moderate Risk (mBIG 2)
# GCS 15, Non-displaced fracture, 5mm IPH
mbig_score(15, 0, 0, 0, "non_displaced", 0, 0, 5, "none", 0)

# Example 3: High Risk (mBIG 3)
# GCS 15, On Warfarin (Anti-coag)
mbig_score(15, 0, 1, 0, "none", 0, 0, 0, "none", 0)