{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T06:57:20Z","timestamp":1793170640552,"version":"4.5.0"},"reference-count":70,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Pediatric traumatic brain injury (TBI) represents a significant public health concern and source of resource utilization. The aim of this study was to establish the ability of the previously published pediatric Brain Injury Guidelines (pBIG) to identify patients with traumatic intracranial hemorrhage (ICH) who might not require routine repeat neuroimaging, neurosurgical consultation, or hospital admission in a large level I and level II trauma cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Pediatric patients who presented with traumatic ICH between 2018 and 2022 at the included institutions were retrospectively reviewed and sorted into pBIG categories using clinical and radiographic criteria. Nonaccidental trauma was excluded. Repeat neuroimaging and results, neurosurgical intervention, length of stay (LOS), and 30-day mortality and re-presentation to healthcare were collected as outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>A cohort of 955 patients (median age 7.0 years, with 64.5% of patients being male) were included. Overall, 9.7% of patients had pBIG 1 injuries, 30.0% had pBIG 2 injuries, and 60.2% had pBIG 3 injuries. A total of 368 (38.5%) of patients underwent repeat neuroimaging, of whom 144 (39.1%) showed progression of hemorrhage. Neurosurgical intervention was performed in 129 (13.5%) patients, with 127 (98.4%) of them meeting pBIG 3 criteria on arrival. The two remaining patients met pBIG 2 criteria on arrival and then progressed to meet pBIG 3 criteria within 24 hours. Patient meeting pBIG 3 criteria were significantly more likely to have progression on repeat imaging, require neurosurgical intervention, and experience 30-day mortality (p &lt; 0.001). Within the pBIG 3 cohort, there was not a significant relationship between progression on repeat imaging and the need for intervention (p = 0.61). Post hoc pairwise testing of individual radiographic pBIG groupings revealed pBIG 3 criteria for all categories except subarachnoid hemorrhage (SAH) to be predictive of need for neurosurgical intervention (p &lt; 0.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Algorithmic management of mild TBI is beneficial to patient care. With zero and near-zero rates of neurosurgical intervention and mortality in patients with pBIG 1 and pBIG 2 injuries, respectively, the pBIG are valid in stratifying a larger and broader population of pediatric TBI patients. In contrast to other pBIG 3\u2013defined compartment ICHs, \"scattered\" SAH does not correlate with need for neurosurgical intervention. However, these guidelines have the ability to safely improve care and decrease unnecessary resource utilization without negatively affecting patient outcomes. Utilization of guidelines of any sort are not intended to supersede clinical judgment. Prospective studies are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.7.peds24229","type":"journal-article","created":{"date-parts":[[2025,1,3]],"date-time":"2025-01-03T21:18:38Z","timestamp":1735939118000},"page":"214-221","source":"Crossref","is-referenced-by-count":6,"title":["The pediatric Brain Injury Guidelines: a retrospective clinical validation study"],"prefix":"10.3171","volume":"35","author":[{"given":"Lindsey M.","family":"Freeman","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Bothwell","sequence":"additional","affiliation":[{"name":"Research in Outcomes of Children\u2019s Surgery, Children\u2019s Hospital of Colorado Anschutz Medical Campus, Aurora;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Pazniokas","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Mecum","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine, Aurora;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khoa","family":"Nguyen","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine, Aurora;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler D.","family":"Park","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine, Aurora;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan V.","family":"Ryan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s Hospital Colorado Anschutz Medical Campus, Aurora; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek C.","family":"Samples","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Children\u2019s Hospital Colorado Anschutz Medical Campus, Aurora; and"},{"name":"Department of Neurosurgery, Children\u2019s Hospital Colorado, Colorado Springs, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1","series-title":"U.S. Department of Health and Human Services;","article-title":"Surveillance Report of Traumatic Brain Injury-Related Emergency Department Visits, Hospitalizations, and Deaths: United States, 2014. Centers for Disease Control and Prevention,","year":"2019","unstructured":"Surveillance Report of Traumatic Brain Injury-Related Emergency Department Visits, Hospitalizations, and Deaths: United States, 2014. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2019.Accessed October 24, 2024. https:\/\/www.cdc.gov\/traumaticbraininjury\/pdf\/TBI-Surveillance-Report-FINAL_508.pdf"},{"key":"b2","series-title":"U.S. Department of Health and Human Services;","article-title":"Surveillance Report. Traumatic Brain Injury-related Hospitalizations and Deaths by Age Group, Sex, and Mechanism of Injury. United States 2016 \/ 2017. Centers for Disease Control and Prevention,","year":"2021","unstructured":"Surveillance Report. Traumatic Brain Injury-related Hospitalizations and Deaths by Age Group, Sex, and Mechanism of Injury. United States 2016 \/ 2017. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2021."},{"key":"b3","series-title":"Am J Emerg Med","first-page":"208","article-title":"Factors associated with avoidable interhospital transfers for children with a minor head injury","volume":"45","author":"Mowbray F","year":"2021","unstructured":"Mowbray F, Arora R, Shukla M, Shihan H, Kannikeswaran N. Factors associated with avoidable interhospital transfers for children with a minor head injury. Am J Emerg Med. 2021;45:208\u2013212."},{"issue":"10","key":"b4","series-title":"Am J Public Health","first-page":"e35","article-title":"Health care costs 1 year after pediatric traumatic brain injury","volume":"105","author":"Graves JM","year":"2015","unstructured":"Graves JM, Rivara FP, Vavilala MS. Health care costs 1 year after pediatric traumatic brain injury. Am J Public Health. 2015;105(10):e35\u2013e41."},{"issue":"9","key":"b5","series-title":"J Pediatr Surg","first-page":"1777","article-title":"Use of a mild traumatic brain injury guideline to reduce inpatient hospital imaging and charges","volume":"46","author":"Goldberg J","year":"2011","unstructured":"Goldberg J, McClaine RJ, Cook B,  Use of a mild traumatic brain injury guideline to reduce inpatient hospital imaging and charges. J Pediatr Surg. 2011;46(9):1777\u20131783."},{"issue":"2","key":"b6","series-title":"J Trauma Acute Care Surg","first-page":"292","article-title":"Routine repeat brain computed tomography in all children with mild traumatic brain injury may result in unnecessary radiation exposure","volume":"76","author":"Howe J","year":"2014","unstructured":"Howe J, Fitzpatrick CM, Lakam DR, Gleisner A, Vane DW. Routine repeat brain computed tomography in all children with mild traumatic brain injury may result in unnecessary radiation exposure. J Trauma Acute Care Surg. 2014;76(2):292\u2013296."},{"issue":"10","key":"b7","series-title":"J Pediatr Surg","first-page":"2048","article-title":"Routine surveillance imaging following mild traumatic brain injury with intracranial hemorrhage may not be necessary","volume":"53","author":"Patel SK","year":"2018","unstructured":"Patel SK, Gozal YM, Krueger BM,  Routine surveillance imaging following mild traumatic brain injury with intracranial hemorrhage may not be necessary. J Pediatr Surg. 2018;53(10):2048\u20132054."},{"issue":"6","key":"b8","series-title":"ANZ J Surg","first-page":"438","article-title":"Role of routine repeat head imaging in paediatric traumatic brain injury","volume":"84","author":"Bata SC","year":"2014","unstructured":"Bata SC, Yung M. Role of routine repeat head imaging in paediatric traumatic brain injury. ANZ J Surg. 2014;84(6):438\u2013441."},{"issue":"2","key":"b9","series-title":"AJR Am J Roentgenol","first-page":"289","article-title":"Estimated risks of radiation-induced fatal cancer from pediatric CT","volume":"176","author":"Brenner D","year":"2001","unstructured":"Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol. 2001;176(2):289\u2013296."},{"issue":"1","key":"b10","series-title":"Brain Tumor Res Treat","first-page":"1","article-title":"Risk of brain tumor induction from pediatric head CT procedures: a systematic literature review","volume":"6","author":"Sheppard JP","year":"2018","unstructured":"Sheppard JP, Nguyen T, Alkhalid Y, Beckett JS, Salamon N, Yang I. Risk of brain tumor induction from pediatric head CT procedures: a systematic literature review. Brain Tumor Res Treat. 2018;6(1):1\u20137."},{"issue":"4","key":"b11","series-title":"J Trauma Acute Care Surg","first-page":"965","article-title":"The BIG (brain injury guidelines) project: defining the management of traumatic brain injury by acute care surgeons","volume":"76","author":"Joseph B","year":"2014","unstructured":"Joseph B, Friese RS, Sadoun M,  The BIG (brain injury guidelines) project: defining the management of traumatic brain injury by acute care surgeons. J Trauma Acute Care Surg. 2014;76(4):965\u2013969."},{"issue":"1","key":"b12","series-title":"Trauma Surg Acute Care Open","first-page":"e000483","article-title":"Multicenter assessment of the Brain Injury Guidelines and a proposal of guideline modifications","volume":"5","author":"Khan AD","year":"2020","unstructured":"Khan AD, Elseth AJ, Brosius JA,  Multicenter assessment of the Brain Injury Guidelines and a proposal of guideline modifications. Trauma Surg Acute Care Open. 2020;5(1):e000483."},{"issue":"1","key":"b13","series-title":"J Trauma Acute Care Surg","first-page":"106","article-title":"A multicenter validation of the modified brain injury guidelines: are they safe and effective?","volume":"93","author":"Khan AD","year":"2022","unstructured":"Khan AD, Lee J, Galicia K,  A multicenter validation of the modified brain injury guidelines: are they safe and effective? J Trauma Acute Care Surg. 2022;93(1):106\u2013112."},{"issue":"3","key":"b14","series-title":"J Neurosurg","first-page":"782","article-title":"External validation of the updated Brain Injury Guidelines for complicated mild traumatic brain injuries: a retrospective cohort study","volume":"137","author":"Tourigny JN","year":"2022","unstructured":"Tourigny JN, Boucher V, Paquet V,  External validation of the updated Brain Injury Guidelines for complicated mild traumatic brain injuries: a retrospective cohort study. J Neurosurg. 2022;137(3):782\u2013788."},{"issue":"6","key":"b15","series-title":"J Trauma Acute Care Surg","first-page":"1200","article-title":"Big for small: Validating brain injury guidelines in pediatric traumatic brain injury","volume":"83","author":"Azim A","year":"2017","unstructured":"Azim A, Jehan FS, Rhee P,  Big for small: Validating brain injury guidelines in pediatric traumatic brain injury. J Trauma Acute Care Surg. 2017;83(6):1200\u20131204."},{"key":"b16","series-title":"J Surg Res","first-page":"106","article-title":"Applying pediatric brain injury guidelines at a Level I adult\/pediatric safety-net trauma center","volume":"255","author":"Schwartz J","year":"2020","unstructured":"Schwartz J, Crandall M, Hsu A, Tepas JJ, Joseph B, Yorkgitis BK. Applying pediatric brain injury guidelines at a Level I adult\/pediatric safety-net trauma center. J Surg Res. 2020;255:106\u2013110."},{"issue":"3","key":"b17","series-title":"J Pediatr Surg","first-page":"552","article-title":"BIG Kids: application of a modified brain injury guideline in a pediatric trauma center","volume":"58","author":"McNickle AG","year":"2023","unstructured":"McNickle AG, Jones SA, Yacoub M,  BIG Kids: application of a modified brain injury guideline in a pediatric trauma center. J Pediatr Surg. 2023;58(3):552\u2013557."},{"issue":"6","key":"b18","series-title":"Am J Surg","first-page":"1182","article-title":"Not every trauma patient with a radiographic head injury requires transfer for neurosurgical evaluation: Application of the brain injury guidelines to patients transferred to a level 1 trauma center","volume":"214","author":"Capron GK","year":"2017","unstructured":"Capron GK, Voights MB, Moore HR III, Wall DB. Not every trauma patient with a radiographic head injury requires transfer for neurosurgical evaluation: Application of the brain injury guidelines to patients transferred to a level 1 trauma center. Am J Surg. 2017;214(6):1182\u20131185."},{"issue":"6","key":"b19","series-title":"J Neurosurg","first-page":"1880","article-title":"External retrospective validation of Brain Injury Guidelines criteria and modified guidelines for improved care value in the management of patients with low-risk neurotrauma","volume":"133","author":"Ross M","year":"2019","unstructured":"Ross M, Pang PS, Raslan AM, Selden NR, Cetas JS. External retrospective validation of Brain Injury Guidelines criteria and modified guidelines for improved care value in the management of patients with low-risk neurotrauma. J Neurosurg. 2019;133(6):1880\u20131885."},{"issue":"2","key":"b20","series-title":"J Trauma Acute Care Surg","first-page":"157","article-title":"Validating the Brain Injury Guidelines: results of an American Association for the Surgery of Trauma prospective multi-institutional trial","volume":"93","author":"Joseph B","year":"2022","unstructured":"Joseph B, Obaid O, Dultz L,  Validating the Brain Injury Guidelines: results of an American Association for the Surgery of Trauma prospective multi-institutional trial. J Trauma Acute Care Surg. 2022;93(2):157\u2013165."},{"key":"b21","series-title":"J Surg Res","first-page":"117","article-title":"Implementation of a traumatic brain injury guideline at a Department of Defense Level 1 trauma center","volume":"272","author":"Vitale D","year":"2022","unstructured":"Vitale D, Bohan PK, How R, Arnold-Lloyd T, Aden JK, Sams V. Implementation of a traumatic brain injury guideline at a Department of Defense Level 1 trauma center. J Surg Res. 2022;272:117\u2013124."},{"issue":"2","key":"b22","series-title":"J Trauma Acute Care Surg","first-page":"320","article-title":"The impact of low-dose aspirin in the Brain Injury Guidelines on outcomes in traumatic brain injury: a retrospective cohort study","volume":"94","author":"Webb AJ","year":"2023","unstructured":"Webb AJ, Oetken HJ, Plott AJ,  The impact of low-dose aspirin in the Brain Injury Guidelines on outcomes in traumatic brain injury: a retrospective cohort study. J Trauma Acute Care Surg. 2023;94(2):320\u2013327."},{"key":"b23","series-title":"Am J Emerg Med","first-page":"37","article-title":"The Brain Injury Guidelines (BIG) and emergency department observation and admission rates: a retrospective cohort study","volume":"82","author":"Southerland LT","year":"2024","unstructured":"Southerland LT, Alnemer A, Laufenberg C, Nimjee SM, Bischof JJ. The Brain Injury Guidelines (BIG) and emergency department observation and admission rates: a retrospective cohort study. Am J Emerg Med. 2024;82:37\u201341."},{"issue":"6","key":"b24","series-title":"Am J Surg","first-page":"845","article-title":"First steps toward a BIG change: a pilot study to implement the Brain Injury Guidelines across a 24-hospital system","volume":"226","author":"Kay AB","year":"2023","unstructured":"Kay AB, Malone SA, Bledsoe JR, Majercik S, Morris DS. First steps toward a BIG change: a pilot study to implement the Brain Injury Guidelines across a 24-hospital system. Am J Surg. 2023;226(6):845\u2013850."},{"key":"b25","series-title":"World Neurosurg","first-page":"e86","article-title":"Implementation of the modified Brain Injury Guidelines might be feasible and cost-effective even in a nontrauma hospital","volume":"187","author":"Krause KL","year":"2024","unstructured":"Krause KL, Brown A, Michael J,  Implementation of the modified Brain Injury Guidelines might be feasible and cost-effective even in a nontrauma hospital. World Neurosurg. 2024;187:e86\u2013e93."},{"key":"b26","series-title":"Am J Emerg Med","first-page":"127","article-title":"Identification and management of low-risk isolated traumatic brain injury patients initially treated at a rural level IV trauma center","volume":"78","author":"Nene RV","year":"2024","unstructured":"Nene RV, Corbett B, Lambert G,  Identification and management of low-risk isolated traumatic brain injury patients initially treated at a rural level IV trauma center. Am J Emerg Med. 2024;78:127\u2013131."},{"issue":"6","key":"b27","series-title":"J Trauma Acute Care Surg","first-page":"944","article-title":"Reducing low-value interhospital transfers for mild traumatic brain injury","volume":"96","author":"Shen A","year":"2024","unstructured":"Shen A, Mizraki N, Maya M,  Reducing low-value interhospital transfers for mild traumatic brain injury. J Trauma Acute Care Surg. 2024;96(6):944\u2013948."},{"issue":"1114","key":"b28","series-title":"Br J Radiol","first-page":"20190968","article-title":"Characteristics of pediatric patients with traumatic epidural hematomas who can be safely observed: a clinical validation study","volume":"93","author":"Call L","year":"2020","unstructured":"Call L, Qiu Q, Morris J,  Characteristics of pediatric patients with traumatic epidural hematomas who can be safely observed: a clinical validation study. Br J Radiol. 2020;93(1114):20190968."},{"issue":"2","key":"b29","series-title":"J Pediatr Surg","first-page":"334","article-title":"Pediatric patients with traumatic epidural hematoma at low risk for deterioration and need for surgical treatment","volume":"52","author":"Flaherty BF","year":"2017","unstructured":"Flaherty BF, Moore HE, Riva-Cambrin J, Bratton SL. Pediatric patients with traumatic epidural hematoma at low risk for deterioration and need for surgical treatment. J Pediatr Surg. 2017;52(2):334\u2013339."},{"issue":"3 Suppl","key":"b30","series-title":"Neurosurgery","first-page":"S7","article-title":"Surgical management of acute epidural hematomas","volume":"58","author":"Bullock MR","year":"2006","unstructured":"Bullock MR, Chesnut R, Ghajar J,  Surgical management of acute epidural hematomas. Neurosurgery. 2006;58(3 Suppl):S7-S15, Si-iv."},{"issue":"3 Suppl","key":"b31","series-title":"Neurosurgery","first-page":"S16","article-title":"Surgical management of acute subdural hematomas","volume":"58","author":"Bullock MR","year":"2006","unstructured":"Bullock MR, Chesnut R, Ghajar J,  Surgical management of acute subdural hematomas. Neurosurgery. 2006;58(3 Suppl):S16-S24, Si-iv."},{"issue":"3 Suppl","key":"b32","series-title":"Neurosurgery","first-page":"S25","article-title":"Surgical management of traumatic parenchymal lesions","volume":"58","author":"Bullock MR","year":"2006","unstructured":"Bullock MR, Chesnut R, Ghajar J,  Surgical management of traumatic parenchymal lesions. Neurosurgery. 2006;58(3 Suppl):S25\u2013S46."},{"key":"b33","series-title":"StatPearls","article-title":"Pediatric head trauma","author":"Haydel MJ","year":"2024","unstructured":"Haydel MJ, Weisbrod LJ, Saeed W. Pediatric head trauma. In: StatPearls. StatPearls Publishing; 2024.Accessed October 24, 2024. http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK537029\/"},{"issue":"9","key":"b34","series-title":"Pediatr Rev","first-page":"468","article-title":"Pediatric head trauma: a review and update","volume":"40","author":"Gelineau-Morel RN","year":"2019","unstructured":"Gelineau-Morel RN, Zinkus TP, Le Pichon JB. Pediatric head trauma: a review and update. Pediatr Rev. 2019;40(9):468\u2013481."},{"issue":"3","key":"b35","series-title":"ANZ J Surg","first-page":"202","article-title":"Paediatric mild head injury: is routine admission to a tertiary trauma hospital necessary?","volume":"88","author":"Tallapragada K","year":"2018","unstructured":"Tallapragada K, Peddada RS, Dexter M. Paediatric mild head injury: is routine admission to a tertiary trauma hospital necessary? ANZ J Surg. 2018;88(3):202\u2013206."},{"key":"b1","series-title":"U.S. Department of Health and Human Services;","article-title":"Surveillance Report of Traumatic Brain Injury-Related Emergency Department Visits, Hospitalizations, and Deaths: United States, 2014. Centers for Disease Control and Prevention,","year":"2019","unstructured":"Surveillance Report of Traumatic Brain Injury-Related Emergency Department Visits, Hospitalizations, and Deaths: United States, 2014. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2019.Accessed October 24, 2024. https:\/\/www.cdc.gov\/traumaticbraininjury\/pdf\/TBI-Surveillance-Report-FINAL_508.pdf"},{"key":"b2","series-title":"U.S. Department of Health and Human Services;","article-title":"Surveillance Report. Traumatic Brain Injury-related Hospitalizations and Deaths by Age Group, Sex, and Mechanism of Injury. United States 2016 \/ 2017. Centers for Disease Control and Prevention,","year":"2021","unstructured":"Surveillance Report. Traumatic Brain Injury-related Hospitalizations and Deaths by Age Group, Sex, and Mechanism of Injury. United States 2016 \/ 2017. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2021."},{"key":"b3","series-title":"Am J Emerg Med","first-page":"208","article-title":"Factors associated with avoidable interhospital transfers for children with a minor head injury","volume":"45","author":"Mowbray F","year":"2021","unstructured":"Mowbray F, Arora R, Shukla M, Shihan H, Kannikeswaran N. Factors associated with avoidable interhospital transfers for children with a minor head injury. Am J Emerg Med. 2021;45:208\u2013212."},{"issue":"10","key":"b4","series-title":"Am J Public Health","first-page":"e35","article-title":"Health care costs 1 year after pediatric traumatic brain injury","volume":"105","author":"Graves JM","year":"2015","unstructured":"Graves JM, Rivara FP, Vavilala MS. Health care costs 1 year after pediatric traumatic brain injury. Am J Public Health. 2015;105(10):e35\u2013e41."},{"issue":"9","key":"b5","series-title":"J Pediatr Surg","first-page":"1777","article-title":"Use of a mild traumatic brain injury guideline to reduce inpatient hospital imaging and charges","volume":"46","author":"Goldberg J","year":"2011","unstructured":"Goldberg J, McClaine RJ, Cook B,  Use of a mild traumatic brain injury guideline to reduce inpatient hospital imaging and charges. J Pediatr Surg. 2011;46(9):1777\u20131783."},{"issue":"2","key":"b6","series-title":"J Trauma Acute Care Surg","first-page":"292","article-title":"Routine repeat brain computed tomography in all children with mild traumatic brain injury may result in unnecessary radiation exposure","volume":"76","author":"Howe J","year":"2014","unstructured":"Howe J, Fitzpatrick CM, Lakam DR, Gleisner A, Vane DW. Routine repeat brain computed tomography in all children with mild traumatic brain injury may result in unnecessary radiation exposure. J Trauma Acute Care Surg. 2014;76(2):292\u2013296."},{"issue":"10","key":"b7","series-title":"J Pediatr Surg","first-page":"2048","article-title":"Routine surveillance imaging following mild traumatic brain injury with intracranial hemorrhage may not be necessary","volume":"53","author":"Patel SK","year":"2018","unstructured":"Patel SK, Gozal YM, Krueger BM,  Routine surveillance imaging following mild traumatic brain injury with intracranial hemorrhage may not be necessary. J Pediatr Surg. 2018;53(10):2048\u20132054."},{"issue":"6","key":"b8","series-title":"ANZ J Surg","first-page":"438","article-title":"Role of routine repeat head imaging in paediatric traumatic brain injury","volume":"84","author":"Bata SC","year":"2014","unstructured":"Bata SC, Yung M. Role of routine repeat head imaging in paediatric traumatic brain injury. ANZ J Surg. 2014;84(6):438\u2013441."},{"issue":"2","key":"b9","series-title":"AJR Am J Roentgenol","first-page":"289","article-title":"Estimated risks of radiation-induced fatal cancer from pediatric CT","volume":"176","author":"Brenner D","year":"2001","unstructured":"Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol. 2001;176(2):289\u2013296."},{"issue":"1","key":"b10","series-title":"Brain Tumor Res Treat","first-page":"1","article-title":"Risk of brain tumor induction from pediatric head CT procedures: a systematic literature review","volume":"6","author":"Sheppard JP","year":"2018","unstructured":"Sheppard JP, Nguyen T, Alkhalid Y, Beckett JS, Salamon N, Yang I. Risk of brain tumor induction from pediatric head CT procedures: a systematic literature review. Brain Tumor Res Treat. 2018;6(1):1\u20137."},{"issue":"4","key":"b11","series-title":"J Trauma Acute Care Surg","first-page":"965","article-title":"The BIG (brain injury guidelines) project: defining the management of traumatic brain injury by acute care surgeons","volume":"76","author":"Joseph B","year":"2014","unstructured":"Joseph B, Friese RS, Sadoun M,  The BIG (brain injury guidelines) project: defining the management of traumatic brain injury by acute care surgeons. J Trauma Acute Care Surg. 2014;76(4):965\u2013969."},{"issue":"1","key":"b12","series-title":"Trauma Surg Acute Care Open","first-page":"e000483","article-title":"Multicenter assessment of the Brain Injury Guidelines and a proposal of guideline modifications","volume":"5","author":"Khan AD","year":"2020","unstructured":"Khan AD, Elseth AJ, Brosius JA,  Multicenter assessment of the Brain Injury Guidelines and a proposal of guideline modifications. Trauma Surg Acute Care Open. 2020;5(1):e000483."},{"issue":"1","key":"b13","series-title":"J Trauma Acute Care Surg","first-page":"106","article-title":"A multicenter validation of the modified brain injury guidelines: are they safe and effective?","volume":"93","author":"Khan AD","year":"2022","unstructured":"Khan AD, Lee J, Galicia K,  A multicenter validation of the modified brain injury guidelines: are they safe and effective? J Trauma Acute Care Surg. 2022;93(1):106\u2013112."},{"issue":"3","key":"b14","series-title":"J Neurosurg","first-page":"782","article-title":"External validation of the updated Brain Injury Guidelines for complicated mild traumatic brain injuries: a retrospective cohort study","volume":"137","author":"Tourigny JN","year":"2022","unstructured":"Tourigny JN, Boucher V, Paquet V,  External validation of the updated Brain Injury Guidelines for complicated mild traumatic brain injuries: a retrospective cohort study. J Neurosurg. 2022;137(3):782\u2013788."},{"issue":"6","key":"b15","series-title":"J Trauma Acute Care Surg","first-page":"1200","article-title":"Big for small: Validating brain injury guidelines in pediatric traumatic brain injury","volume":"83","author":"Azim A","year":"2017","unstructured":"Azim A, Jehan FS, Rhee P,  Big for small: Validating brain injury guidelines in pediatric traumatic brain injury. J Trauma Acute Care Surg. 2017;83(6):1200\u20131204."},{"key":"b16","series-title":"J Surg Res","first-page":"106","article-title":"Applying pediatric brain injury guidelines at a Level I adult\/pediatric safety-net trauma center","volume":"255","author":"Schwartz J","year":"2020","unstructured":"Schwartz J, Crandall M, Hsu A, Tepas JJ, Joseph B, Yorkgitis BK. Applying pediatric brain injury guidelines at a Level I adult\/pediatric safety-net trauma center. J Surg Res. 2020;255:106\u2013110."},{"issue":"3","key":"b17","series-title":"J Pediatr Surg","first-page":"552","article-title":"BIG Kids: application of a modified brain injury guideline in a pediatric trauma center","volume":"58","author":"McNickle AG","year":"2023","unstructured":"McNickle AG, Jones SA, Yacoub M,  BIG Kids: application of a modified brain injury guideline in a pediatric trauma center. J Pediatr Surg. 2023;58(3):552\u2013557."},{"issue":"6","key":"b18","series-title":"Am J Surg","first-page":"1182","article-title":"Not every trauma patient with a radiographic head injury requires transfer for neurosurgical evaluation: Application of the brain injury guidelines to patients transferred to a level 1 trauma center","volume":"214","author":"Capron GK","year":"2017","unstructured":"Capron GK, Voights MB, Moore HR III, Wall DB. Not every trauma patient with a radiographic head injury requires transfer for neurosurgical evaluation: Application of the brain injury guidelines to patients transferred to a level 1 trauma center. Am J Surg. 2017;214(6):1182\u20131185."},{"issue":"6","key":"b19","series-title":"J Neurosurg","first-page":"1880","article-title":"External retrospective validation of Brain Injury Guidelines criteria and modified guidelines for improved care value in the management of patients with low-risk neurotrauma","volume":"133","author":"Ross M","year":"2019","unstructured":"Ross M, Pang PS, Raslan AM, Selden NR, Cetas JS. External retrospective validation of Brain Injury Guidelines criteria and modified guidelines for improved care value in the management of patients with low-risk neurotrauma. J Neurosurg. 2019;133(6):1880\u20131885."},{"issue":"2","key":"b20","series-title":"J Trauma Acute Care Surg","first-page":"157","article-title":"Validating the Brain Injury Guidelines: results of an American Association for the Surgery of Trauma prospective multi-institutional trial","volume":"93","author":"Joseph B","year":"2022","unstructured":"Joseph B, Obaid O, Dultz L,  Validating the Brain Injury Guidelines: results of an American Association for the Surgery of Trauma prospective multi-institutional trial. J Trauma Acute Care Surg. 2022;93(2):157\u2013165."},{"key":"b21","series-title":"J Surg Res","first-page":"117","article-title":"Implementation of a traumatic brain injury guideline at a Department of Defense Level 1 trauma center","volume":"272","author":"Vitale D","year":"2022","unstructured":"Vitale D, Bohan PK, How R, Arnold-Lloyd T, Aden JK, Sams V. Implementation of a traumatic brain injury guideline at a Department of Defense Level 1 trauma center. J Surg Res. 2022;272:117\u2013124."},{"issue":"2","key":"b22","series-title":"J Trauma Acute Care Surg","first-page":"320","article-title":"The impact of low-dose aspirin in the Brain Injury Guidelines on outcomes in traumatic brain injury: a retrospective cohort study","volume":"94","author":"Webb AJ","year":"2023","unstructured":"Webb AJ, Oetken HJ, Plott AJ,  The impact of low-dose aspirin in the Brain Injury Guidelines on outcomes in traumatic brain injury: a retrospective cohort study. J Trauma Acute Care Surg. 2023;94(2):320\u2013327."},{"key":"b23","series-title":"Am J Emerg Med","first-page":"37","article-title":"The Brain Injury Guidelines (BIG) and emergency department observation and admission rates: a retrospective cohort study","volume":"82","author":"Southerland LT","year":"2024","unstructured":"Southerland LT, Alnemer A, Laufenberg C, Nimjee SM, Bischof JJ. The Brain Injury Guidelines (BIG) and emergency department observation and admission rates: a retrospective cohort study. Am J Emerg Med. 2024;82:37\u201341."},{"issue":"6","key":"b24","series-title":"Am J Surg","first-page":"845","article-title":"First steps toward a BIG change: a pilot study to implement the Brain Injury Guidelines across a 24-hospital system","volume":"226","author":"Kay AB","year":"2023","unstructured":"Kay AB, Malone SA, Bledsoe JR, Majercik S, Morris DS. First steps toward a BIG change: a pilot study to implement the Brain Injury Guidelines across a 24-hospital system. Am J Surg. 2023;226(6):845\u2013850."},{"key":"b25","series-title":"World Neurosurg","first-page":"e86","article-title":"Implementation of the modified Brain Injury Guidelines might be feasible and cost-effective even in a nontrauma hospital","volume":"187","author":"Krause KL","year":"2024","unstructured":"Krause KL, Brown A, Michael J,  Implementation of the modified Brain Injury Guidelines might be feasible and cost-effective even in a nontrauma hospital. World Neurosurg. 2024;187:e86\u2013e93."},{"key":"b26","series-title":"Am J Emerg Med","first-page":"127","article-title":"Identification and management of low-risk isolated traumatic brain injury patients initially treated at a rural level IV trauma center","volume":"78","author":"Nene RV","year":"2024","unstructured":"Nene RV, Corbett B, Lambert G,  Identification and management of low-risk isolated traumatic brain injury patients initially treated at a rural level IV trauma center. Am J Emerg Med. 2024;78:127\u2013131."},{"issue":"6","key":"b27","series-title":"J Trauma Acute Care Surg","first-page":"944","article-title":"Reducing low-value interhospital transfers for mild traumatic brain injury","volume":"96","author":"Shen A","year":"2024","unstructured":"Shen A, Mizraki N, Maya M,  Reducing low-value interhospital transfers for mild traumatic brain injury. J Trauma Acute Care Surg. 2024;96(6):944\u2013948."},{"issue":"1114","key":"b28","series-title":"Br J Radiol","first-page":"20190968","article-title":"Characteristics of pediatric patients with traumatic epidural hematomas who can be safely observed: a clinical validation study","volume":"93","author":"Call L","year":"2020","unstructured":"Call L, Qiu Q, Morris J,  Characteristics of pediatric patients with traumatic epidural hematomas who can be safely observed: a clinical validation study. Br J Radiol. 2020;93(1114):20190968."},{"issue":"2","key":"b29","series-title":"J Pediatr Surg","first-page":"334","article-title":"Pediatric patients with traumatic epidural hematoma at low risk for deterioration and need for surgical treatment","volume":"52","author":"Flaherty BF","year":"2017","unstructured":"Flaherty BF, Moore HE, Riva-Cambrin J, Bratton SL. Pediatric patients with traumatic epidural hematoma at low risk for deterioration and need for surgical treatment. J Pediatr Surg. 2017;52(2):334\u2013339."},{"issue":"3 Suppl","key":"b30","series-title":"Neurosurgery","first-page":"S7","article-title":"Surgical management of acute epidural hematomas","volume":"58","author":"Bullock MR","year":"2006","unstructured":"Bullock MR, Chesnut R, Ghajar J,  Surgical management of acute epidural hematomas. Neurosurgery. 2006;58(3 Suppl):S7-S15, Si-iv."},{"issue":"3 Suppl","key":"b31","series-title":"Neurosurgery","first-page":"S16","article-title":"Surgical management of acute subdural hematomas","volume":"58","author":"Bullock MR","year":"2006","unstructured":"Bullock MR, Chesnut R, Ghajar J,  Surgical management of acute subdural hematomas. Neurosurgery. 2006;58(3 Suppl):S16-S24, Si-iv."},{"issue":"3 Suppl","key":"b32","series-title":"Neurosurgery","first-page":"S25","article-title":"Surgical management of traumatic parenchymal lesions","volume":"58","author":"Bullock MR","year":"2006","unstructured":"Bullock MR, Chesnut R, Ghajar J,  Surgical management of traumatic parenchymal lesions. Neurosurgery. 2006;58(3 Suppl):S25\u2013S46."},{"key":"b33","series-title":"StatPearls","article-title":"Pediatric head trauma","author":"Haydel MJ","year":"2024","unstructured":"Haydel MJ, Weisbrod LJ, Saeed W. Pediatric head trauma. In: StatPearls. StatPearls Publishing; 2024.Accessed October 24, 2024. http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK537029\/"},{"issue":"9","key":"b34","series-title":"Pediatr Rev","first-page":"468","article-title":"Pediatric head trauma: a review and update","volume":"40","author":"Gelineau-Morel RN","year":"2019","unstructured":"Gelineau-Morel RN, Zinkus TP, Le Pichon JB. Pediatric head trauma: a review and update. Pediatr Rev. 2019;40(9):468\u2013481."},{"issue":"3","key":"b35","series-title":"ANZ J Surg","first-page":"202","article-title":"Paediatric mild head injury: is routine admission to a tertiary trauma hospital necessary?","volume":"88","author":"Tallapragada K","year":"2018","unstructured":"Tallapragada K, Peddada RS, Dexter M. Paediatric mild head injury: is routine admission to a tertiary trauma hospital necessary? ANZ J Surg. 2018;88(3):202\u2013206."}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/35\/3\/article-p214.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/35\/3\/article-p214.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/35\/3\/article-p214.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T13:46:47Z","timestamp":1772804807000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/35\/3\/article-p214.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,1]]},"references-count":70,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3171\/2024.7.peds24229","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,1]]}}}