Emergency Department Management of Mild Traumatic Brain Injury in New Delhi–A Single Institute Cohort Management Data

Abstract

Introduction The purpose of this study is to compare the current clinical management practices and decision guidelines of the Brain Trauma Foundation (BTF) for mild traumatic brain insult with line of treatment followed at our center to identify the clinically significant treatment outcome in pediatric to elderly patients. Materials and Methods This is a questionnaire-based prospective observational study at the emergency department of neurosurgery in Dr. Ram Manohar Lohia (RML) Hospital, New Delhi. A registry questionnaire was administered to all the eligible subjects by the neurosurgery resident in emergency department (ED) to correlate clinical status, severity of traumatic brain injury (TBI) and associated comorbid conditions and its outcome after management. Results Out of 154 mild TBI cases attending ED, 115 (74.7%) were males and 39 (25.3%) were females, with average age of 27 years. Of the patients with mild TBI, road traffic accidents (RTA) were the main cause (50.6%), followed by fall from height (42.9%), assault and sports-related injury (6.4%). Of the total, 96.1% underwent CT. Of these, 31.8% found abnormal CT results, 27.5% received wound treatment care, and 9.1% received emergency care. Nearly 30.5% were admitted and 1.3% patients were died in the hospital, 75.3% patients were discharged and 23.4% were referred to other department for associated co morbid conditions. Conclusion The present study identified deficiencies in and variation around several important aspects of ED care. The development of BTF guidelines specific for mild TBI could reduce variation and improve emergency care for this injury.

The Secondary Impact of Mild Traumatic Brain Injury: An Interpretative Phenomenological Analysis of the Experiences of Family Members

“…TBI is experienced as an invisible injury by families in both studies. This invisibility adds to the person with mTBI's challenge of being understood and supported by medical services (Childers & Hux, 2016). As discussed, patient education often sets the expectation of recovery within 3 months (Torbay and South Devon Trust, 2018;University Hospitals Birmingham Trust, 2018), despite recent findings that most people with mTBI experience symptoms beyond then (Hiploylee et al, 2017;Nelson et al, 2019;Dikmen et al, 2017;Theadom et al, 2018;McInnes et al, 2017).…”

“…Table A1 in Appendix A expands on a comparison of treatment guidelines by Silverberg et al (2020) by including UK guidelines. It shows that TBI information provided under NICE guidelines is not mTBI specific (Doneva, 2018), which may lead to variation and reduced care in the emergency department (Choudhary et al, 2022). NICE guidelines make no mention of mTBI, potentially perpetuating the lack of education about chronic phase mTBI (Hart et al, 2018).…”