Break through
barriers in mild
tbi evaluation

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break
through
barriers in
mild tbi
evaluation

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break through
barriers in mild tbi
evaluation

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Mild traumatic brain injury (mTBI) (commonly called “concussion”) in the emergency department (ED) or acute care

Approximately half of mTBI patients suffer from long-term TBI-related functional limitations and/or neuropsychological sequalae.1,2

Per a recent study, more than half of mTBI patients received no follow-up care or educational materials relating to TBI at discharge from the ED.3

While “mTBI” is often referred to as “concussion”, mTBI is often described as a diagnosis immediately following injury and
concussion is often used to describe the constellation of symptoms following the injury. 7,8

Challenges and opportunities for the ed

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mTBI challanges in the ED

The ED is the main gateway to medical care for millions of patients evaluated for TBI each year.4

Evaluation challenges

Patient Care Challenge Patient Care Challenge Patient Care Challenge parallax
  • A study based on retrospective data concluded evaluation for mTBI was estimated at 401 minutes (6.6 hours) in EDs. Time related to head CT comprised about one-half of the total length of stay.5
  • Among patients who receive CT scans for TBI, 91% do not have evidence of traumatic abnormalities.4
  • Despite high prevalence and potential implications of mTBI, accurate diagnosis and prognosis remain challenging and more accurate, definitive assessment tools are needed.2,4 

Patient care challenges

Patient Care Challenge Patient Care Challenge Patient Care Challenge parallax
  • Patient population and presentation are largely heterogeneic.2
  • Approximately 50% of patients with mTBI suffer from long-term TBI-related functional limitations and/or neuropsychological sequalae.1,2
  • Evidence demonstrates that 56% of patients receive no follow-up care, and 58% of patients receive no educational materials relating to TBI at discharge from the ED.3
  • More than half of patients subsequently proven to have mTBI did not receive a TBI diagnosis in the ED.6

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References:
 1.Nelson LD, Temkin NR, Dikmen S, et al. Recovery after mild traumatic brain injury in patients presenting to US level I trauma centers. JAMA Neurol.2019;76(9):1049.
2.Yue JK, Cnossen MC, Winkler EA, et al. Pre-injury comorbidities are associated with functional impairment and postconcussive symptoms at 3-and 6-months after mild traumatic brain injury: a TRACK-TBI study. Front Neurol. 2019;10:343.
3.Seabury SA, Gaudette E, Goldman DP, et al. Assessment of follow-up care after emergency department presentation for mild traumatic brain injury and concussion: results from the TRACK-TBI study. JAMA Netw Open. 2018;1(1):e180210.
4.Korley FK, Kelen GD, Jones CM, et al. Emergency department evaluation of traumatic brain injury in the united states, 2009–2010. J Head Trauma Rehabil. 2015;31(6):379-387.
5.Michelson EA, Huff JS, Loparo M, et al. Emergency department time course for mild traumatic brain injury workup. West J Emerg Med. 2018;19(4):635-640.
6.Powell JM, Ferraro JV, Dikmen SS, et al. Accuracy of mild traumatic brain injury diagnosis. Arch Phys Med Rehabil. 2008;89:1550-1555.
7.The Management of Concussion-mild Traumatic Brain Injury Working Group, VA/DoD Clinical Practice Guidelines for the Management of Concussion-Mild Traumatic Injury, Version 2.0, 2016
8.Sussman ES, Pendhark AV, Ho AL, et al. Mild traumatic brain injury and concussion: terminology and classification. Handbook of Clinical Neurology. 2018; Vol. 158, Chapter 3.

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