Objective
Determine the dimensions of traumatic brain injury (TBI) evaluation in U.S. emergency department (EDs) to inform potential application of novel diagnostic tests.
Setting
United States EDs.
Participants
National Hospital Ambulatory Medical Care Survey of ED visits in 2009 and 2010 where TBI was evaluated (1) and diagnosed clinically, or (2) with head CT scan.
Design
Retrospective cross-sectional.
Results
TBI was evaluated during 4.8 (95% CI: 4.2–5.4) million visits/year; and head CT scan was performed in 82% of TBI evaluations (3.9 [95% CI: 3.4–4.4] million visits/year). TBI was diagnosed in 52% of evaluations (2.5 [95% CI: 2.1–2.8] million visits/year). Among those who received head CTs, 9% had CT evidence of traumatic abnormalities. Among patients evaluated for TBI who had a Glasgow Coma Scale recorded, 94.5% were classified as mild TBI, 2.1% as moderate TBI and 3.5% as severe TBI. Among patients with ICD9-C-M codes permitting the calculation of Head AIS scores 9.0%, 85.0%, 2.5%, 3.2%, 0.3% and 0% had Head AIS scores of 1,2,3,4,5,6 respectively. Of patients evaluated for TBI, 31% had other head/face/neck injuries; 10% had spine and back injuries; 7% had torso injuries; and 14% had extremity injuries.
Conclusion
The ED is the main gateway to medical care for millions of patients evaluated for TBI each year. Novel diagnostic tests are need to improve ED diagnosis and management of TBI.