The Emergency Department is on the front line of mTBI.
The workload and accountability of TBI patient management lies predominately with the ED physician.1,2
The terms “concussion” and “TBI” are often used interchangeably, both in medical literature and in clinical practice. Some clinicians may prefer the term “concussion” when communicating with patients and caregivers since it suggests a transient condition and avoids the stigma associated with brain damage or brain injury. 15,16
“mTBI” is described as a diagnosis made in the period immediately following injury from a traumatic event resulting in disruption of consciousness, memory, mental clarity, or other normal neurologic function. “Concussion” is often used to describe the constellation of signs and symptoms following such an injury. 16
Approximately one third of mTBI patients experience a variety of cognitive, emotional, psychosocial, and behavioral post-concussion symptoms. When a cluster of these symptoms persists for more than 3 months they are often classified as “post-concussion syndrome” (PCS).17
1.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.
2.Coronado VG, Haileyesus T, Cheng TA, et al. Trends in sports-and recreation-related traumatic brain injuries treated in US emergency departments: the national electronic injury surveillance system-all injury program (NEISS-AIP) 2001-2012. J Head Trauma Rehabil. 2015;30(3):185-197.
3.American Society of Neuroradiology Website. Available at: https://www.asnr.org/patientinfo/conditions/tbi.shtml [Accessed Sept 18, 2019].
4.Anon. Traumatic Brain Injury. Johns Hopkins Medicine Website. Available at: www.hopkinsmedicine.org/health/conditions-and-diseases/traumatic-brain-injury [Accessed Sept 13,2019].
5.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.
6.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.
7.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.
8.Zhou Y, Kierans A, Kenul D, et al. Mild traumatic brain injury: longitudinal regional brain volume changes. Radiology. 2013;267(3):880-890.
9.Zahniser E, Temkin NR, Machamer J, et al. The functional status examination in mild traumatic brain injury: a TRACK-TBI sub-study. Arch Clin Neuropsychol. 2019;34(7):1165-1174.
10.Centers for Disease Control and Prevention (CDC) Website. Available at: https://www.cdc.gov/headsup/pdfs/providers/facts_about_concussion_tbi-a.pdf [Accessed Sept 18, 2019] and at https://www.cdc.gov/traumaticbraininjury/outcomes.html [Accessed June 3, 2020].
11.Bey T, Ostick B. Second impact syndrome. West J Emerg Med. 2009;10(1):6-10.
12.GBD 2016 Traumatic Brain Injury and Spinal Cord Injury Collaborators. Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18:56-87.
13.Wang KK, Yang Z, Zhu T, et al. An update on diagnostic and prognostic biomarkers for traumatic brain injury. Expert Rev Mol Diagn. 2018;18(2):165-180.
14.Stein MB, Jain S, Gia JT, et al. Risk of posttraumatic stress disorder and major depression in civilian patients after mild traumatic brain injury: a TRACK-TBI study. JAMA Psychiatry. 2019;76(3):249-258. doi:10.1001/jamapsychiatry.2018.4288.
15.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
16.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.
17.Voormolen DC, Cnossen MC, Polinder S. Divergent Classification Methods of Post-Concussion Syndrome after Mild Traumatic Brain Injury: Prevalence Rates, Risk Factors, and Functional Outcome. Journal of Neurotrauma. 2018; 35: 1233-1241.