Understanding Why Patients Return to the Emergency Department after Mild Traumatic Brain Injury within 72 Hours

Ganti, Latha; Conroy, Lauren M.; Bodhit, Aakash; Daneshvar, Yasamin; Patel, Pratik; Ayala, Sarah; Kuchibhotla, Sudeep; Hatchitt, Kelsey; Pulvino, Christa; Peters, Keith; Lottenberg, Lawrence

doi:10.5811/westjem.2015.2.23546

Cited by 25 publications

(21 citation statements)

References 15 publications

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“…In conflict with our study, male gender was reported to be a positive predictor for ED revisits within 72 hours of discharge. 10 , 13 , 18 It may not be possible to compare our findings with those of these studies due to methodological issues, since Ganti et al 13 studied specific population, patients with mild traumatic brain injury. Ahmed et al 19 studied patients with sickle cell disease.…”

Section: Discussionmentioning

confidence: 89%

“…The ED revisit within 72 hours has been widely reported in earlier studies, and its rate depends on the chronic disease status and the cultural background. 6 – 12 The rates of 72-hour ED revisits may depend on age, 10 , 11 gender, 10 , 13 disease categories, 6 – 8 , 12 medical errors, 7 , 8 patients, 7 and doctors. 7 Although data regarding ED revisits within 72 hours can be used to implement changes and modifications to improve the electronic medical record database, the rate of revisits to the ED within 72 hours has not been documented among adults with chronic diseases in Saudi Arabia, particularly in our center.…”

Section: Introductionmentioning

confidence: 99%

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Seventy-two-hour emergency department revisits among adults with chronic diseases: a Saudi Arabian study

Ahmed

AlBuraikan

Almazroa

et al. 2018

TCRM

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BackgroundDespite the increase in adult emergency department (ED) utilization in Saudi Arabia, no studies have evaluated the 72-hour revisits. This study estimates the rate of 72-hour ED revisits and identifies its reasons and predictive factors among adults with chronic diseases.Patients and methodsA hospital-based retrospective study that included 24,206 ED discharges for adults with chronic diseases at the adult ED of King Abdulaziz Medical City, Riyadh between September 13, 2015 and July 29, 2017 was performed. We extracted data on demographic information, reasons for ED visits/revisits, health insurance coverage, weekend ED arrival, and mortality.ResultsA sample of 24,206 ED discharges for 19,697 adults with at least one chronic disease was included in the analysis. The rate of 72-hour revisits in this study population was high: 3,144/24,206 (13%) had the first revisit and 319/3,144 (10.1%) had the second ED revisit within 72 hours. Diseases of the circulatory (19%) and genitourinary (15.8%) systems were the major reasons for the first ED revisit. The adjusted relative rate (aRR) of 72-hour ED revisits was higher in adults with chronic diseases and aged ≥60 years (aRR=1.360, 95% CI: 1.41–1.83; P=0.001), patients of female gender (aRR=1.24, 95% CI: 1.09–1.41; P=0.001), patients with health insurance coverage (aRR=4.23, 95% CI: 2.60–6.90; P=0.001), patients arriving to ED on a weekend (aRR=2.13, 95% CI: 1.03–4.41; P=0.041), and new patients (aRR=1.47, 95% CI: 1.25–1.73; P=0.001).ConclusionThe rate of 72-hour revisits is high among adults with chronic diseases. Advancing age, female gender, health insurance coverage, weekend ED arrival, and new patients are the important predictive factors of the high rate of 72-hour revisits. Continuous quality assessment and monitoring of factors related to patients are needed to reduce the frequency of early ED revisits after discharge.

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Seventy-two-hour emergency department revisits among adults with chronic diseases: a Saudi Arabian study

Ahmed

AlBuraikan

Almazroa

et al. 2018

TCRM

View full text Add to dashboard Cite

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“…Nonetheless, this might lead to another clinical problem. Intracranial hemorrhage is associated with increased incidence of postconcussion syndrome and postconcussion headache [39,40]. Treatment is available for these patients, but if they are not identified by emergency head CT, another means of identifying them is necessary so they can be offered treatment [41,42].…”

Section: Discussionmentioning

confidence: 99%

A proposed amendment to the current guidelines for mild traumatic brain injury: reducing computerized tomographies while maintaining safety

Vedin

Karlsson

Edelhamre

et al. 2019

Eur J Trauma Emerg Surg

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Purpose Head trauma is a common complaint in emergency departments. Identifying patients with serious injuries can be difficult and generates many computerized tomographies. Reducing the number of computerized tomographies decreases both cost and radiation exposure. The aim of this study was to evaluate whether the current Scandinavian Neurotrauma Committee guidelines could be revised in such a way that would enable hospitals to perform fewer computerized tomographies while maintaining the ability to identify all patients requiring neurological intervention. Methods A retrospective study of the medical records of adult patients suffering a traumatic brain injury was performed. A total of 1671 patients over a period of 365 days were included, and 25 parameters were extracted. Multitrauma patients managed with ATLS™ were excluded. The Scandinavian Neurotrauma Committee guidelines were amended with the previously derived "low-risk proposal" and applied retrospectively to the cohort. Results Incidence of intracranial hemorrhage was 5.6% (93/1671). Application of the current Scandinavian Neurotrauma Committee guidelines would have resulted in 860 computerized tomographies and would have missed 11 intracranial hemorrhages. The proposed amendment with the low-risk proposal would have resulted in 748 CT scans and would have missed 19 intracranial hemorrhages (a relative reduction of 13%). None of the missed intracranial hemorrhages required neurological intervention. Conclusion For patients with mild and moderate traumatic brain injuries, application of the Scandinavian Neurotrauma Committee guidelines amended with the low-risk proposal may result in a significant reduction of computerized tomographies without missing any patients in need of neurological intervention.

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“…Traumatic brain injury (TBI) accounts for over 1 million US emergency department visits annually [1], 275,000 civilian hospitalizations [2] and 21,000 military [3] injuries. Traumatic brain injury can have lasting consequences with neurocognitive deficits [4][5][6][7], post concussive symptoms [8][9][10], and repeat return visits to the emergency department [11].…”

Section: Introductionmentioning

confidence: 99%

GCS 15: when mild TBI isn’t so mild

Ganti

Stead

Daneshvar

et al. 2019

Neurol. Res. Pract.

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Objective: The present study characterizes patients with the mildest of mild traumatic brain injury (TBI), as defined by a Glasgow coma score (GCS) of 15. Methods: This is an IRB approved observational cohort study of adult patients who presented to the emergency department of a Level-1 trauma center, with the primary diagnosis of TBI and a GCS score of 15 on arrival. Data collected included demographic variables such as age, gender, race, mechanisms of injury, signs and symptoms including associated vomiting, seizures, loss of consciousness (LOC), alteration of consciousness (AOC), and posttraumatic amnesia (PTA).Pre-hospital GCS, Emergency Department (ED) GCS, and results of brain CT scans were also collected as well as patient centered outcomes including hospital or intensive care unit (ICU) admission, neurosurgical intervention, and in hospital death. Data were stored in REDCap (Research Electronic Data Capture), a secure, web-based application. Descriptive and inferential analysis was done using JMP 14.0 for the Mac. Results: Univariate predictors of hospital admission included LOC, AOC, and PTA, all p < 0.0001. Patients admitted to ICU were significantly more likely to be on an antiplatelet or anticoagulant (P < 0.0001), have experienced PTA (p = 0.0025), LOC (p < 0.0001), or have an abnormal brain CT (p < 0.0001). Patients who died in the hospital were significantly more likely to be on an antiplatelet or anticoagulant (P = 0.0005. All who died in the hospital had intracranial hemorrhage on ED head CT, despite having presented to the ED with GCS of 15. Patients were also significantly more likely to have had vomiting (p < 0.0001). Patients who underwent neurosurgical intervention were significantly more likely to be male (P = 0.0203), to be on an antiplatelet or anticoagulant (P = < 0.0001) likely to have suffered their TBI from a fall (P = 0.0349), and experienced vomiting afterwards (P = 0.0193). Conclusions: This study underscores: 1) the importance of neuroimaging in all patients with TBI, including those with a GCS 15. Fully 10% of our cohort was not imaged. Extrapolating, these would represent 2.5% bleeds, and 1.47% fractures. 2) The limitations of GCS in classifying TBI, as patients with even the mildest of mild TBI have a high frequency of gross CT abnormalities.

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Understanding Why Patients Return to the Emergency Department after Mild Traumatic Brain Injury within 72 Hours

Cited by 25 publications

References 15 publications

Seventy-two-hour emergency department revisits among adults with chronic diseases: a Saudi Arabian study

Seventy-two-hour emergency department revisits among adults with chronic diseases: a Saudi Arabian study

A proposed amendment to the current guidelines for mild traumatic brain injury: reducing computerized tomographies while maintaining safety

GCS 15: when mild TBI isn’t so mild

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