Slide 1: Pediatric Patient with Traumatic Brain Injury (TBI) Abbreviations IVH: Intraventricular Hemorrhage SAH: Subarachnoid Hemorrhage ICH: Intracranial Hemorrhage EDH: Epidural Hematoma SDH: Subdural Hematoma IPH: Intraparenchymal Hemorrhage Displaced skull fracture > 1 cranium width Radiographic Findings IVH EDH ≥8mm SDH ≥8mm IPH ≥ 8mm or multiple SAH >3 sulci AND bi-hemispheric Clinical Findings GCS ≤12 Anticoagulation or antiplatelet Non-accidental trauma (NAT) mechanism YES YES kBIG 3 High Risk Transfer / Admit to pediatric trauma center with neurosurgery consultation available YES YES Isolated Skull Fracture Clinical Findings GCS 15 Radiographic Findings No ICH Non-displaced skull fracture or mildly displaced < 1 cranium width If worsening: neuro exam If worsening: neuro exam If worsening: neuro exam Patients with > 1 ICH area should be classified as kBig 3 Patients can have a non-displaced or minimally displaced skull fracture in addition to a bleed in kBIG 1 & 2 Kay AB, Glasgow SL, Kahan AM, Swendiman RA, Kastenberg ZJ, Roach CM, Wan HY, Bollo RJ, Iyer RR, Ravindra VM, Morris DS, Yorkgitis BK, Joseph B, Russell KW. Small Change, BIG Impact: Proposal of the Brain Injury Guidelines for Kids (kBIG).J Pediatr Surg. 2025 May 17:162372. doi: 10.1016/j.jpedsurg.2025.162372. kBIG 2 Medium Risk Transfer / Admit to pediatric trauma center with neurosurgery consultation available NO neurosurgical consultation NO repeat head CT GCS 15 at discharge Follow up concussion clinic kBIG 1 Low Risk Discharge from Emergency Department NO repeat head CT NO neurosurgical consultation Follow up concussion clinic kBIG 0 Low risk isolated skull fracture Discharge from Emergency Department NO repeat head CT NO neurosurgical consultation Follow up concussion clinic Confirm Intracranial Hemorrhage Size Clinical Findings GCS 15 Radiographic Findings SDH ≤4mm IPH ≤4mm SAH ≤3 sulci (total) Are ANY of the following present? Radiographic Findings EDH <8mm SDH 4.1 – 7.9mm IPH 4.1 – 7.9mm SAH>3 sulci, single hemisphere Clinical Findings GCS 13-14 Persistent nausea, vomiting, intractable headache Intoxication Are ANY of the following present? [Speaker notes] Internal
From
Dr. Katie W. Russell
kBIG 3.26
Document · Jun 2026 · 1 min read
In brief
In brief
The kBIG classification system stratifies pediatric traumatic brain injury patients into four risk categories based on radiographic findings (hemorrhage type, size, location) and clinical factors (GCS score, mechanism, anticoagulation status). This algorithm guides disposition decisions including neurosurgery consultation needs, transfer requirements, and discharge safety for children with head trauma.
- kBIG stratifies pediatric TBI into 4 risk levels (0-3) based on GCS, bleed size, and skull fracture displacement to guide transfer decisions.
- High-risk kBIG 3 criteria: GCS ≤12, bleeds ≥8mm, displaced skull fracture >1 cranium width, anticoagulation, or NAT mechanism.
- Isolated non-displaced skull fractures with GCS 15 and no ICH (kBIG 0) can be discharged without repeat CT or neurosurgery consult.
- Medium-risk kBIG 2 includes GCS 13-14, EDH <8mm, or SDH/IPH 4.1-7.9mm—requires transfer but may avoid neurosurgery if stable.
- Low-risk kBIG 1 (GCS 15, small bleeds ≤4mm) can be discharged from ED with concussion clinic follow-up, no repeat imaging needed.
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