Brain Injury Screening Tool: a guide to TBI assessment

The Brain Injury Screening Tool (BIST) helps health practitioners assess and manage suspected brain injury (or concussion) in people over 8 years old.

The BIST takes about 6 minutes to complete.

How to use BIST

• Use when someone first presents to you and you suspect a brain injury (concussion)
• Follow the prompts and enter patient responses
• First 12 questions identify if there are clinical indicators that the person is at high risk of complications and requires hospital evaluation
• The symptom checklist is designed to assist in identifying patients at:
  • Moderate risk of poor recovery or who need specialist referral
  • Low risk patients who are likely to recover well and can be supported with ongoing monitoring and advice
• The impact of injury item assesses overall impact of injury on the person’s life.
• Additional questioning and tests to add to the clinical picture are encouraged (like balance or visual tests)

Once completed the tool will provide a suggestion on the best healthcare pathway for a patient, although it is only a guide. Final decision-making lies with the clinician. Use of the tool can be halted at any time if an urgent hospital referral is indicated. Some questions do not need to be asked if the injury was less than 24 hours ago. The symptom scale and impact question can be repeated at follow up to monitor recovery over time.

Download and use the tool

• Download BIST-ED (for use in the Emergency Department)
• Download BIST-2 (for primary care and allied health services including physiotherapy)

What's changed from the original BIST

Download the summary to read an overview of the changes made to the BIST based on research evidence and clinical implementation learnings.

Download summary of changes since last version

Why use BIST

BIST aims to help guide the clinical consultation by operationalising current international best practice guidelines and research evidence on predictors of recovery.

• Designed to be used on initial presentation after injury to guide the clinical consultation.
• Identifies patients who are at low, medium or high risk of longer-term difficulties based on known risk factors and predictors of recovery.
• Provides guidance on health care pathway decision making (such as guidance on when to refer to hospital or a concussion service).
• It's quick (only takes 6 minutes)
• Can be used as part of the consultation – it is designed to flow as a routine consultation would.
• Highlights those who may need a specialist referral, for example physio

Review on a digital platform

We recently completed a review of how the BIST was working as an outcome measure in a concussion service as part of a project looking at measuring patient outcomes using a digital platform

Download the report

Feasibility study

We recently completed a feasibility study of a manual screening process for mild TBI in Middlemore Emergency Department.

Download the full report

Publications

• Brain Injury Screening Tool (BIST): test–retest reliability in a community adult sample
• Rasch Analysis of The Brain Injury Screening Tool (BIST) in Mild Traumatic Brain Injury - article in Research Square
• The Brain Injury Screening Tool (BIST): Tool development, factor structure and validity - article in Plos One