Modified brain injury guidelines in a regional Australian setting indicate significant resource savings but also safety concerns

Traumatic brain injury (TBI) is a major cause of emergency department (ED) presentation globally and accounts for more than 60% of trauma-related deaths.1 In Australia, TBI represents 1.3%–2% of all ED presentations, with a hospitalised incidence of 99.1 per 100 000 population.2 Although most TBIs are mild and fewer than 1% require neurosurgical intervention,3 many patients receive neurosurgical consultations (NSCs), repeat CT scans or inter-hospital transfers, reflecting considerable resource use. In New South Wales (NSW), guidelines mandate NSC for any abnormal CT brain, leading to high use of NSCs.4 The Brain Injury Guidelines (BIG) and modified BIG (mBIG), developed in the USA, aim to safely reduce imaging, consultations and admissions by stratifying TBI severity.5 6 These pathways have demonstrated improved resource use without compromising outcomes5 but have not been evaluated in Australia. This study aimed to assess the mBIG retrospectively in a regional setting without onsite neurosurgical services and to quantify potential reductions in resource utilisation.