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Peer-reviewedCC BYJournal of Pediatric Surgery Open

Successful implementation of the Brain Injury Guidelines for Kids (kBIG) in a regional trauma network

  • Anastasia M. Kahan1
  • Kacey M. Barnes2
  • Annika B. Kay3
  • Sommer L. Glasgow4
  • Robert A. Swendiman4
  • Zachary J. Kastenberg4
  • Christopher M. Roach2
  • Hsuan-Yu Wan2
  • Robert J. Bollo5
  • Rajiv R. Iyer5
  • Vijay M. Ravindra5
  • Katie W. Russell4
5 affiliations
  1. 1University of Utah, Division of Pediatric Surgery, Salt Lake City, UT, United States; Corresponding author at: University of Utah, 100 Mario Capecchi Dr, Salt Lake City, Utah, 84113, United States.
  2. 2Intermountain Health, Primary Children’s Hospital, Salt Lake City, UT, United States
  3. 3Intermountain Health, Intermountain Medical Center, Salt Lake City, UT, United States
  4. 4University of Utah, Division of Pediatric Surgery, Salt Lake City, UT, United States
  5. 5University of Utah, Department of Neurosurgery, Salt Lake City, UT, United States
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Abstract

Background: Management of pediatric traumatic brain injury varies widely across hospitals. The Brain Injury Guidelines for Kids (kBIG), published in 2025, provide a framework for risk-stratified care. We describe implementation of kBIG across a regional trauma network using coordinated system-level quality improvement practices. Methods: A quality improvement initiative was conducted across the Utah Pediatric Trauma Network (UPTN), a 57-hospital regional trauma system. Following publication of the guideline, the tertiary care center Primary Children’s Hospital (PCH) along with its satellite site, Lehi Children’s (LC), led network-wide implementation of kBIG using iterative Plan–Do–Study–Act (PDSA) cycles. As the tertiary referral center, PCH maintained real-time awareness of patients across the network through a centralized telehealth consultation system; in addition, we systematically reviewed patients across Intermountain Health (IHC), the largest hospital system within the UPTN, to ensure comprehensive case identification and monitoring. Guideline adherence and patient outcomes were reviewed weekly, with monthly performance improvement dashboards shared across the network. Ongoing education, case review, and iterative refinements were used to support implementation and ensure adherence and safety. Results: kBIG reporting increased from a nadir of 75% one month post-launch to 100% at 9 months at the tertiary center. A total of 455 pediatric patients with traumatic intracranial injury were identified and classified across the trauma system according to kBIG criteria in one calendar year. Among these patients, 122 (27%) were categorized as kBIG 0, 74 (16%) were categorized as kBIG 1, 72 (16%) as kBIG 2, and 187 (41%) as kBIG 3. Conclusions: A structured quality improvement approach using PDSA cycles, real-time data feedback, and regional collaboration enabled successful implementation of kBIG. This model may provide a scalable framework for implementing evidence-based pediatric trauma protocols.

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Cite

BibTeXRIS
BibTeX
@article{kahan2026successful,
  title = {{Successful implementation of the Brain Injury Guidelines for Kids (kBIG) in a regional trauma network}},
  author = {Anastasia M. Kahan and Kacey M. Barnes and Annika B. Kay and Sommer L. Glasgow and Robert A. Swendiman and Zachary J. Kastenberg and Christopher M. Roach and Hsuan-Yu Wan and Robert J. Bollo and Rajiv R. Iyer and Vijay M. Ravindra and Katie W. Russell},
  journal = {Journal of Pediatric Surgery Open},
  year = {2026},
  month = oct,
  doi = {10.1016/j.yjpso.2026.100314},
  url = {https://doi.org/10.1016/j.yjpso.2026.100314},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Successful implementation of the Brain Injury Guidelines for Kids (kBIG) in a regional trauma network
AU  - Anastasia M. Kahan
AU  - Kacey M. Barnes
AU  - Annika B. Kay
AU  - Sommer L. Glasgow
AU  - Robert A. Swendiman
AU  - Zachary J. Kastenberg
AU  - Christopher M. Roach
AU  - Hsuan-Yu Wan
AU  - Robert J. Bollo
AU  - Rajiv R. Iyer
AU  - Vijay M. Ravindra
AU  - Katie W. Russell
PY  - 2026
DA  - 2026/10/30
JO  - Journal of Pediatric Surgery Open
DO  - 10.1016/j.yjpso.2026.100314
UR  - https://doi.org/10.1016/j.yjpso.2026.100314
AB  - Background: Management of pediatric traumatic brain injury varies widely across hospitals. The Brain Injury Guidelines for Kids (kBIG), published in 2025, provide a framework for risk-stratified care. We describe implementation of kBIG across a regional trauma network using coordinated system-level quality improvement practices. Methods: A quality improvement initiative was conducted across the Utah Pediatric Trauma Network (UPTN), a 57-hospital regional trauma system. Following publication of the guideline, the tertiary care center Primary Children’s Hospital (PCH) along with its satellite site, Lehi Children’s (LC), led network-wide implementation of kBIG using iterative Plan–Do–Study–Act (PDSA) cycles. As the tertiary referral center, PCH maintained real-time awareness of patients across the network through a centralized telehealth consultation system; in addition, we systematically reviewed patients across Intermountain Health (IHC), the largest hospital system within the UPTN, to ensure comprehensive case identification and monitoring. Guideline adherence and patient outcomes were reviewed weekly, with monthly performance improvement dashboards shared across the network. Ongoing education, case review, and iterative refinements were used to support implementation and ensure adherence and safety. Results: kBIG reporting increased from a nadir of 75% one month post-launch to 100% at 9 months at the tertiary center. A total of 455 pediatric patients with traumatic intracranial injury were identified and classified across the trauma system according to kBIG criteria in one calendar year. Among these patients, 122 (27%) were categorized as kBIG 0, 74 (16%) were categorized as kBIG 1, 72 (16%) as kBIG 2, and 187 (41%) as kBIG 3. Conclusions: A structured quality improvement approach using PDSA cycles, real-time data feedback, and regional collaboration enabled successful implementation of kBIG. This model may provide a scalable framework for implementing evidence-based pediatric trauma protocols.
SN  - 2949-7116
ER  -