ER patients at risk for concussion often do not receive proper evaluations or education
This content was originally authored by Julian Szieff in the 5/28/20 edition of our biweekly Concussion Update newsletter
A recent study, published in the Annals of Emergency Medicine, evaluated 98 patients for their level of mild traumatic brain injury (mTBI) care in an academic level 1 trauma center. During the 4-week observational study, data were evaluated to see if potential mTBI patients received an mTBI evaluation, diagnosis, or discharge education. Researchers Rachel R Koval et al. found that there was no documentation of an mTBI evaluation for 50% of the “patients at high risk for mild traumatic brain injury.” Furthermore, of the 36 patients who received an mTBI diagnosis, only 15 received mTBI specific discharge information.
Patients were identified by a triage nurse based on symptomology questions during triage. (Was there a blunt force trauma? Was there a change in the level of consciousness as a result of the event?) Evaluation, education, and treatment data were pulled from clinician documentation. One concern with the data from this study is that evaluations and education could have occurred without documentation, but that would be another concerning issue.
Additionally concerning is that this study was conducted at a level 1 academic trauma center, a large extremely professional medical center. For smaller, less well-staffed medical centers, the number of patients receiving inappropriate evaluation or education could be even greater. Emergency room doctors are often the only providers that an mTBI patient will see. The evaluations, treatments, and information provided are essential point-of-care measures for appropriate care and rehabilitation. The lack of evaluation, diagnosis, and mTBI specific education is an important issue that ER departments should focus on to improve mTBI care and recovery.
