Challenges in the acute identification of mild traumatic brain injuries: results from an emergency department surveillance study

Ilaria Pozzato, Susanne Meares, Annette Kifley, Ashley Craig, Mark Gillett, Kim Van Vu, Anthony Liang, Ian Cameron, Bamini Gopinath

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    6 Citations (Scopus)
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    Abstract

    Objectives To establish the proportion of mild traumatic brain injury (mTBI) diagnosis among people presenting to an emergency department (ED), to determine the accuracy of recorded ED diagnoses. We also aimed to describe challenges in mTBI case identification and its acute hospital management.

    Design and setting A retrospective chart review of all ED attendances to a major trauma hospital, over a 9-month period (June 2015–February 2016).

    Participants Adults aged 18–65 years consecutively presenting to an ED.

    Primary outcome measures Proportion of mTBI diagnosis among ED attendances (ie, confirmed mTBI based on the WHO criteria or indeterminate mTBI based on secondary criteria), and proportion of accurately recorded mTBI diagnosis by ED clinicians (ie, ‘mTBI’, ‘concussion’).

    Results Of 30 479 ED attendances, 351 (1.15%) confirmed mTBI diagnosis and 180 (0.6%) indeterminate diagnosis were identified. Only 81 (23.1%) individuals with a confirmed mTBI had a ‘mTBI diagnosis’ clearly recorded in the medical notes. Of the allocated discharge diagnosis codes to the two identified cohorts, 89.8% were not indicative of mTBI. Intracranial injuries were found in 31 (8.5%) confirmed cases. Glasgow Coma Scale scores were consistently assessed in the ED but identified only 117 (33.3%) confirmed mTBI cases. Post-traumatic amnesia (PTA) testing was able to confirm acute cognitive impairment in 113 (62.1%) of those who were tested (182, 51.3%).

    Conclusions mTBI is a common, but an under-recognised cause for ED attendance. Despite challenges, the use of an operational definition such as the WHO diagnostic criteria can improve accuracy in mTBI identification. Acute management may be enhanced by rapid assessment of PTA.
    Original languageEnglish
    Article numbere034494
    Pages (from-to)1-11
    Number of pages11
    JournalBMJ Open
    Volume10
    Issue number2
    DOIs
    Publication statusPublished - Feb 2020

    Bibliographical note

    Copyright the Author(s) 2020. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.

    Keywords

    • accident & emergency medicine
    • epidemiology
    • neurological injury
    • public health
    • trauma management

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