The American College of Emergency Physicians (ACEP) in collaboration with the Centers for Disease Control and Prevention (CDC) have revised the clinical guidelines related to mild traumatic brain injuries in adult patients, which is expected to lead to better patient outcomes for the more than one million patients treated in emergency department every year for mild traumatic brain injury (TBI), or concussion.
The real incidence of traumatic brain injury (TBI) is unknown since many patients who sustain an injury never seek medical care. The majority of these injuries are classified as mild, meaning the patient is alert, oriented and functional when they are assessed in the emergency department. It is estimated that 10 percent of patients with a mild TBI have evidence of an intracranial injury on head computed tomography (CT), and that approximately one percent of patients with mild TBI harbor a life-threatening neurosurgical lesion. The challenge for the emergency physician is to identify which patients with a head injury have an acute traumatic intracranial injury, and which patients can be safely sent home.
Mild TBI results from direct trauma to the head or from an acceleration/deceleration stress to the brain. Mild TBI poses a risk for short-term difficulties with symptoms such as headache, difficulty with balance, thinking, concentrating and sleeping. Up to 80 percent of patients report some symptoms related to the injury at three months. In cases where mild TBI results in long-term problems the diagnosis is often termed, post-concussive syndrome.
The revised guidelines address the following four key questions and offer recommended courses of action:
- Which patients with mild TBI should have a non-contrast head CT scan in the emergency department?
- Is there a role for head MRI over non-contrast CT in the emergency department evaluation of a patient with acute mild TBI?
- In patients with mild TBI, are brain-specific serum biomarkers predictive of an acute traumatic intracranial injury?
- Can a patient with an isolated mild TBI and a normal neurologic evaluation result be safely discharged from the emergency department if a non-contrast head CT scan shows no evidence of intracranial injury?
For more information on the 2008 guidelines on MTBI, visit: http://www.acep.org/practres.aspx?id=30060.
For more information on traumatic brain injury (TBI), visit CDC on the Web at: www.cdc.gov/Injury.