TY  - JOUR
PY  - 2020//
TI  - Challenges in the acute identification of mild traumatic brain injuries: results from an emergency department surveillance study
JO  - BMJ open
A1  - Pozzato, Ilaria
A1  - Meares, Susanne
A1  - Kifley, Annette
A1  - Craig, Ashley
A1  - Gillett, Mark
A1  - Vu, Kim Van
A1  - Liang, Anthony
A1  - Cameron, Ian
A1  - Gopinath, Bamini
SP  - e034494
EP  - e034494
VL  - 10
IS  - 2
N2  - 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'). <br><br>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%). <br><br>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.<br><br>© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.<p />  <p>Language: en</p>
LA  - en
SN  - 2044-6055
UR  - http://dx.doi.org/10.1136/bmjopen-2019-034494
ID  - ref1
ER  -