Emergency Department Time Course for Mild Traumatic Head Injury Workup.

Michelson EA, Huff S, Loparo M, Naunheim R, Perron A, Rahm M, Smith D, Stone J, Berger A

Western Journal of Emergency, 2018; 19(4):635-640.

According to the United States (U.S.) Centers for Disease Control and Prevention, the incidence of traumatic brain injury (TBI) has increased by nearly 60% from calendar-year (CY) 2001 to CY2010 (from 521 per 100,000 persons to 824 per 100,000 persons).1 Visits to the emergency department (ED) resulting in a diagnosis of TBI increased by 29.1% (95% confidence interval [CI], 18.9%–39.2%) in the time period 2006 to 2010, whereas the total number of ED visits increased by only 3.6% (95% CI [-0.7%–8.0%]) during the same period.2 A recent analysis suggests that nearly five million patients present to U.S. EDs annually to be evaluated for head injury, and that approximately one-half of them are diagnosed with a TBI.3 Further, most patients who present to the ED with suspected TBI have mild TBI (mTBI), estimated to be as high as 94.5%.4,5

In addition to obtaining a detailed patient history and thorough physical examination, computed tomography (CT) head imaging has frequently been part of the diagnostic workup, and has been recommended for most if not all patients with suspected mTBI.4-6 CTs are now typically performed on >80% of patients who present to the ED with suspected TBI.7 However, there has been growing concern about the radiation exposure and cost associated with CT. The decision to obtain a head CT also adds time to the ED visit. Download the PDF