Emergency Physician Training on Mild Traumatic Brain Injury: A Systematic Review

Abstract

Objectives: Mild traumatic brain injury (mTBI) is the most common emergency department (ED) brain injury presentation worldwide. Despite its frequency, practice variation and care gaps exist among emergency physicians (EPs) in diagnosing and appropriately managing mTBI in the ED. The objective of this review was to identify mTBI-specific training undertaken to improve the detection and management of mTBIs by EPs and its impact on practice.Methods: A comprehensive search strategy utilized four bibliographic databases, the gray literature and the keywords concussion, mild traumatic brain injury, medical education, and continuing medical education (CME). To be included, studies were required to report on mTBI training received by practicing EPs at any point during their medical education or career. Studies examining clinical practice guidelines or use of diagnostic tools without active implementation or formal training were not included. Two reviewers screened unique citations for relevance and reviewed the full texts of relevant articles. Two independent researchers extracted data and assessed methodologic quality. At all stages, a third independent reviewer adjudicated discrepancies. Results:Overall, five studies were included from 409 unique results. None of the included studies were of high quality. Identified training on mTBI consisted of three training toolkits, conference presentations and academic journal articles, and pediatric fellowship training. Training primarily occurred as CME and focused on awareness of and management of mTBI; three studies reported physician practice changes, including increases in the use of evidence-based return-to-school and return-to-activity recommendations. Conclusions:The few studies identified addressing mTBI training targeting EPs demonstrate the limited attention given to this issue. The current evidence-to-practice gap in mTBI management places patients at risk for suboptimal care in the ED, and existing mTBI knowledge translation, including education, requires optimization to effectively address the current gap in evidence-based practice for mTBI diagnosis and management in the ED.

It's a Hard Knock Life

“…In a systematic review of studies addressing mTBI training resources available to EM providers, investigators highlighted the limited attention that mTBI receives, resulting in variation across mTBI management. 19 In addition, our findings demonstrate that the types of discharge instructions provided were variable based on provider preference, rather than department standard. Finally, the selected ICD-9 or ICD-10 codes may not have captured every patient who presented with mTBI symptoms.…”

“…First, this variability may be because of a knowledge gap among EM providers. In a systematic review of studies addressing mTBI training resources available to EM providers, investigators highlighted the limited attention that mTBI receives, resulting in variation across mTBI management 19 . In addition, our findings demonstrate that the types of discharge instructions provided were variable based on provider preference, rather than department standard.…”

Use of the Sports Concussion Assessment Tool 3 in Emergency Department Patients With Psychiatric Disease

“…The Sports Concussion Assessment Tool 3 (SCAT3) is an assessment of concussion symptomatology that is sometimes used to assist with concussion diagnosis in the ED, as there is no ED specific concussion tool. [7][8][9][10][11][12][13] The SCAT3 was developed for sports and is a sensitive test of postconcussion symptoms in athletes. 6,8,[14][15][16][17][18][19][20] The SCAT3 includes a cognitive screen, a postural stability test, and a symptom evaluation (SE).…”

Heads up for concussion, what do emergency physicians know? A scoping review

“…It has been reported that the rates of concussion are rising year on year, however this may be attributable to increased awareness of the condition by clinicians and the public, particularly through educational efforts (7)(8)(9). Many patients will recover from a concussion within 10 days; however, reports suggest that 10-15% will develop persistent symptoms beyond 4 weeks (10). Persisting concussion symptoms can include: headaches, fatigue, changes in mental health (e.g.…”