AAST Bladder Injury Scale AAST Bowel Injury Scale AAST Cardiac Injury Scale AAST Diaphragm Injury Scale AAST Hepatic Injury Scale AAST Kidney Injury Scale AAST Lung Injury Scale AAST Pancreatic Injury Scale AAST Rectal Injury Scale AAST Splenic Injury Scale AAST Vascular Injury Scale ABC Score (Massive Transfusion)ACS COT Field Triage Guidelines ATLS Hemorrhagic Shock Classification Abbreviated Injury Scale (AIS)Ankle-Brachial Index (ABI) in Trauma Base Deficit in Trauma Brain Injury Guidelines (BIG) Score Cardiac Wound Index Chest Trauma Score (CTS)Damage Control Decision Score (DCDS)Denver Criteria (BCVI)Esophageal Perforation Severity Score (PSS)Expanded Denver Criteria (BCVI)Flint Colon Injury Scale Frailty Index in Trauma (mFI-5)Geriatric Trauma Outcome Score (GTOS)Hard Signs of Vascular Injury Checklist Hemorrhage Control Decision Aid (Wound Packing vs. Tourniquet)ICP-based Cerebral Perfusion Pressure (CPP) Calculator Injury Severity Score (ISS)Injury Severity Score — Age-adjusted (ISS-Age)Lethal Triad / Trauma Triad of Death Calculator Limb Salvage Index (LSI)Mangled Extremity Severity Score (MESS)Mechanism, Glasgow Coma Scale, Age, and Arterial Pressure (MGAP)Memphis Criteria (BCVI)Modified Shock Index (MSI)Nerve Injury, Ischemia, Soft-tissue, Skeletal Injury, Shock, Age (NISSSA)New Injury Severity Score (NISS)Open Abdomen Classification (Björck)Pediatric Trauma Score (PTS)Pelvic Trauma Hemorrhage Risk Score Penetrating Abdominal Trauma Index (PATI)Physiologic Extreme Emergency in Trauma (FEET)Predictive Salvage Index (PSI)REBOA Zone Selection Guide Resuscitative Thoracotomy Indications (EAST/WTA Guidelines)Revised Trauma Score (RTS)RibScore Shock Index (SI)TASH Score TRISS Index Thoracic Trauma Severity Score (TTS)Tile Classification of Pelvic Fractures Trauma and Injury Severity Score — Pediatric (PTS)Young–Burgess Pelvic Fracture Classification

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Brain Injury Guidelines (BIG) Score

Clinical Module Ready

The Brain Injury Guidelines (BIG) Score is currently being validated for clinical use.

Guidelines & Evidence

Verified

Last Review: 2026

When to Use

Primary Indications

Blunt head trauma patients with confirmed intracranial hemorrhage on initial head CT

Patients aged ≥15 years (original validation cohort)

Glasgow Coma Scale (GCS) score 13-15 at presentation

Emergency department and trauma bay evaluation prior to neurosurgical consultation

Rural or community hospital settings where neurosurgical resources are limited

Clinical Utility

The BIG score stratifies mild TBI patients with intracranial hemorrhage into three risk categories, identifying candidates for non-operative management without routine neurosurgical consultation or repeat imaging. It reduces unnecessary transfers to tertiary centers and optimizes resource utilization while maintaining patient safety. The score combines clinical (GCS), radiographic (Marshall CT classification), and laboratory (INR) parameters into a simple additive score (1-3 points).

Comparison with Alternative TBI Tools

Tool	Population	Key Variables	Primary Outcome	Neuro consult requirement
BIG Score	Blunt TBI, GCS 13-15, ICH	GCS, Marshall CT grade, INR	Need for neurosurgical intervention	Explicitly identifies low-risk patients
Marshall CT Classification	All TBI severities	CT findings (midline shift, cisterns, lesion type)	Mortality prediction	No, radiographic only
Rotterdam Score	All TBI severities	CT findings (basal cisterns, midline shift, SAH, epidural mass)	Mortality prediction (6-month)	No, radiographic only
IMPACT Model	Moderate-severe TBI (GCS ≤12)	Clinical, CT, laboratory parameters	6-month functional outcome	No, prognostic model only

Absolute Exclusions

Penetrating head trauma

GCS <13 at any point after presentation

Age <15 years (limited pediatric validation)

Pre-injury anticoagulation with warfarin (INR >1.4) or direct oral anticoagulants (DOACs) - requires different protocol

Platelet count <100,000/μL

Known coagulopathy (hemophilia, liver disease, uremia)

Clinical signs of herniation (Cushing's triad, asymmetric pupils)

Need for emergent decompressive craniectomy or hematoma evacuation

Suspected non-accidental trauma

Pregnancy (limited safety data for withholding repeat imaging)

Injury Mechanism Correlations

The BIG score was validated primarily in blunt trauma mechanisms: falls (41%), motor vehicle collisions (32%), pedestrian struck (15%), and assault (12%). High-energy mechanisms (fall >6 feet, MVC >40 mph, ejection, rollover) are overrepresented in BIG 2 and BIG 3 categories. Low-energy mechanisms (ground-level fall, low-speed MVC) predominate in BIG 1 patients. Penetrating injuries are explicitly excluded from the BIG protocol.

Last Comprehensive Review: 2026