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338783
Prevalence and Persistence of Mild Traumatic Brain Injury Diagnosis among Hospitalized Blunt Trauma Patients


Monday, November 2, 2015

Courtney Marie Cora Jones, PhD, MPH, CPST, Department of Emergency Medicine, University of Rochester, School of Medicine and Dentistry, Rochester, NY
Brian Barlow, MD PhD, Department of Emergency Medicine, University of Rochester, Rochester, NY
Lisa Bergsma, MD, Department of Emergency Medicine, university of Rochester, Rochester, NY
Aaron Rodriguez, MD, Department of Emergency Medicine, University of Rochester, Rochester, NY
Martina Anto-Ocrah, MPH, Department of Emergency Medicine, University of Rochester, Rochetser, NY
Erin B Wasserman, PhD, Department of Public Health Sciences, University of Rochester, Rochester, NY
Jeffrey J Bazarian, MD MPH, Department of Emergency Medicine, University of Rochester, Rochester, NY
BACKGROUND

Symptoms and complications from mild traumatic brain injury (mTBI) can persist after physical recovery from other injuries; however, little is known about the frequency of mTBI among patients with mild-to-moderate injuries and the prevalence of missed mTBI diagnoses in the presence of extracranial injuries.

METHODS

We conducted a retrospective medical record review of adult patients with mild-to-moderate injuries (ISS ≤ 15) who required hospital admission, identified through the trauma registry of a level I trauma center. Subjects were classified as having mTBI if they met the American Congress of Rehabilitation Medicine clinical definition of mTBI. Among those meeting mTBI diagnostic criteria, we then determined the proportion of subjects who were 1) given an mTBI diagnosis during their hospital stay; 2) discharged with an mTBI diagnosis; and 3) provided mTBI discharge instructions.

RESULTS

Of the 297 cases reviewed, 60 cases (20%) met mTBI diagnostic criteria.  Of these patients, 27 (45%) had had documented diagnosis of mTBI in their medical records. Nine of the 27 were diagnosed by in the emergency department and 18 were diagnosed as inpatients. Of the 60 mTBI patients in our sample, only 6 (10%) had mTBI listed on their discharge notes, and only 4 (7%) received discharge instructions specific to head injury.

CONCLUSION

In our sample of hospitalized mild-to-moderately injured patients, mTBI is often under-diagnosed.  Of patients who met diagnostic criteria, the majority do not receive specific discharge instructions for head injury, which could have long-lasting impact on recovery from and proper management of the injury.

Learning Areas:

Basic medical science applied in public health
Clinical medicine applied in public health
Epidemiology

Learning Objectives:
Identify the incidence of mTBI in a population of mild-to-moderately injured patients (ISS ≤ 15) Describe patterns of under-diagnosis of mTBI in this patient population. Discuss the public health and clinical implications related to under-diagnosis of mTBI.

Keyword(s): Emergency Medical Services, Medical Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an injury epidemiologist and an assistant professor in the Departments of Emergency Medicine and Public Health Sciences at the University of Rochester. I have several years of experience conducting large-scale studies related to the acute care provided to injured patients in the emergency care setting.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.