Citation

Cota M, Moses A, Jikaria N, Bittner K, Diaz-Arrastia R, Latour L, Turtzo LC. J. Neurotrauma 2019; 36(8): 1335-1342.

Affiliation

United States ; l.turtzo@nih.gov.

Copyright

(Copyright © 2019, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2018.5772

PMID

30351183

Abstract

Accurate diagnosis of traumatic brain injury (TBI) is critical to ensure patients receive appropriate follow-up care, avoid risk of subsequent injury, and are aware of possible long-term consequences. However, diagnosis of TBI, particularly in the emergency department (ED), can be difficult because the symptoms of TBI are vague and nonspecific, and patients with suspected TBI may present with additional injuries that require immediate medical attention. We performed a retrospective chart review to evaluate accuracy of TBI diagnosis in the ED. Records of 1641 patients presenting to the ED with suspected TBI and a head CT were reviewed. We found only 47% of patients meeting the American Congress of Rehabilitation Medicine (ACRM) criteria for TBI received a documented ED diagnosis of TBI in medical records. After controlling for demographic and clinical factors, patients presenting at a level I trauma center, with cause of injury other than fall, without CT findings of TBI, and without loss of consciousness were more likely to lack documented diagnosis despite meeting diagnostic criteria for TBI. A greater proportion of patients without documented ED diagnosis of TBI were discharged home compared to those with a documented diagnosis of TBI (58% vs 40%, p<0.001). Together these data suggest that many patients who have sustained a TBI are discharged home from the ED without a documented diagnosis of TBI, and that improved awareness and implementation of diagnostic criteria for TBI is important in the ED and for inpatient and outpatient providers.

Language: en

Keywords

HEAD TRAUMA; HUMAN STUDIES; TRAUMATIC BRAIN INJURY