Successful Implementation of Pediatric Brain Injury Guidelines (kBIG) in a Regional Trauma Network

Background Management of pediatric traumatic brain injury varies widely across hospitals. The Pediatric Brain Injury Guidelines (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, 76 (17%) were categorized as kBIG 1, 71 (16%) as kBIG 2, and 186 (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.