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Emergency department management of mild traumatic brain injury in the USA
  1. J J Bazarian1,
  2. J McClung1,
  3. Y T Cheng2,
  4. W Flesher3,
  5. S M Schneider1
  1. 1Department of Emergency Medicine, University of Rochester Medical Center, Rochester, NY, USA
  2. 2Hospital Max Peralta, San Josè, Costa Rica
  3. 3Department of Community and Preventive Medicine, University of Rochester Medical Center, Rochester, NY, USA
  1. Correspondence to:
 Dr J J Bazarian
 Department of Emergency Medicine, University of Rochester Medical Center, Box 655, 601 Elmwood Ave, Rochester, NY 14642 USA; jeff_bazarianurmc.rochester.edu

Abstract

Objective: To describe the emergency department (ED) management of isolated mild traumatic brain injury (TBI) in the USA and to examine variation in care across age and insurance types.

Methods: A secondary analysis of ED visits for isolated mild TBI in the National Hospital Ambulatory Medical Care Survey 1998–2000 was performed. Mild TBI was defined by International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9) codes for skull fracture, concussion, intracranial injury (unspecified), and head injury (unspecified). Available ED care variables were analysed by patient age and insurance categories using multivariate logistic regression.

Results: The incidence of isolated mild TBI cases attending ED was 153 296 per year, or 56.4/100 000 people. Of the patients with isolated mild TBI, 44.3% underwent computed tomography, 23.9% underwent other non-extremity, non-chest x rays, 17.1% received wound care and 14.1% received intravenous fluids. However, only 43.8% had an assessment of pain. Of those with documented pain, only 45.5% received analgesics in the ED. Nearly 38% were discharged without recommendations for specific follow up. Several aspects of ED care varied by age but not by insurance type.

Conclusion: Substantial ED resources are devoted to the care of isolated mild TBI. The present study identified deficiencies in and variation around several important aspects of ED care. The development of guidelines specific for mild TBI could reduce variation and improve emergency care for this injury.

  • CT, computed tomography
  • ED, emergency department
  • MRI, magnetic resonance imaging
  • NHAMCS, National Hospital Ambulatory Medical Care Survey
  • TBI, traumatic brain injury
  • emergency services
  • guidelines
  • traumatic brain injury
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Footnotes

  • Dr Bazarian is supported by a National Institutes of Neurologic Disorders and Stroke Grant 1 K23 NS 41952-04.

  • Competing interests: none declared

  • This work was presented at the Fifth World Congress on Traumatic Brain Injury, 24 May 2003, Stockholm, Sweden.

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