You Cannot Go Home: Routine Concussion Evaluation is not Enough

Hartwell, Jennifer L.; Spalding, M Chance; Fletcher, Brian; OʼMara, Michael Shay; Karas, Chris

doi:10.1177/000313481508100431

Cited by 7 publications

(2 citation statements)

References 15 publications

(20 reference statements)

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“…Hartwell et al ( 2015) 9 . This retrospective study identified 901 patients (age 14 to 93 years ) classified as mild TBI from a trauma registry of 6032 patients admitted to the trauma center between July 2010 and December 2011.…”

Section: Joseph Et Al (2014)mentioning

confidence: 99%

Inpatient management of complicated mTBI with the BIG assessment tool: Review and summary of the evidence

Barber

Wasfie

2023

Trauma

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Introduction The management of mild traumatic brain injury has evolved through the years with an emphasis on the safe discharge of patients given current resources. In this article, we discuss key studies published in the past 12 years that have influenced the direction of complicated mild traumatic brain injury (cmTBI) management. We summarize the evidence on the utilization of the Brain Injury Guideline (BIG) algorithm. Methods An independent literature search was conducted on the BIG, updated versions of BIG, and the prognostic studies of adult mild traumatic brain injury admissions cited by the BIG articles. Evidence resources included the search engines of PubMed, Medline, Ovid, Cochrane Library, and Google Scholar bibliographic databases of items published between 1 January 2010 and 30 December 2021. The evidence focused on BIG and its modified versions, as a potential risk assessment tool for discharging mTBI patients early. Results Studies supporting the BIG algorithm prior to 2019 presented evidence with serious limitations to their findings. These limitations threaten their veracity and fail to support the efficacy or validation of the BIG algorithm's utilization for mTBI patient management. Conclusion The lack of rigor in the BIG algorithm studies suggest the research is currently insufficient to support early discharge and research needs to continue on modified versions of the tool before its widespread use.

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Section: Joseph Et Al (2014)mentioning

confidence: 99%

Inpatient management of complicated mTBI with the BIG assessment tool: Review and summary of the evidence

Barber

Wasfie

2023

Trauma

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“…Many patients who suffer blunt head trauma are at risk of traumatic brain injury (TBI). This affects approximately two million people in the USA each year [ 1 ]. In addition, there are 1.4 million annual hospitalizations for TBI [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Isolated LOC in head trauma associated with significant injury on brain CT scan

et al. 2017

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BackgroundA report of loss of consciousness (LOC) is frequently considered reason enough to obtain a computed tomography (CT) scan in the evaluation of head trauma. We conducted this study to reduce exposure to radiation from CT, while still not overlooking clinically significant injuries.ObjectiveThe objective of the study is to determine the correlation between LOC status and brain CT scan results in patients with blunt head trauma and to determine whether there is a subset of patients for whom CT scan need not be performed, without missing clinically significant intracranial injuries.MethodsThis is a retrospective study conducted in the emergency department of an inner-city hospital. The patient population included patients ranging between 13 and 35 years of age, with blunt head trauma, who presented to the emergency department (ED) between January 2010 and December 2013. Patients were divided into two groups: “LOC” group and “no LOC” group. The results of brain CT scans from each group were compared with LOC status. For study purposes, “clinically significant” were those that required interventions or ICU hospitalization of at least 24 h or extended hospitalization. The results were analyzed using chi-square calculations.ResultsDuring the study period, 494 patients were identified as having suffered head trauma. Of these, 185 (37.5%) reported LOC and 309 (62.5%) did not lose consciousness. In the LOC group, 15 (8.1%) had significant CT findings compared to 1.3% (4/309) of those without LOC (p < .001). Of the 4 who had no LOC and had significant brain CT findings, all 4 patients had positive physical findings of head, neck, or facial trauma. In the LOC group, only 1/15 (6.7%) had significant CT findings with a normal GCS of 15 and no physical signs of the head, neck, or facial trauma.ConclusionsA small proportion of patients with LOC had CT finding requiring intervention. Head trauma patients with no physical injuries to the head, neck, or face and a normal GCS had no significant brain CT findings. This raises the question of whether a routine brain CT scan should be obtained in patients with LOC, no physical findings, and a normal GCS after blunt head trauma.

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Concussion management in the ED: Beyond GCS

Duignan

O’Connor

2016

International Emergency Nursing

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You Cannot Go Home: Routine Concussion Evaluation is not Enough

Cited by 7 publications

References 15 publications

Inpatient management of complicated mTBI with the BIG assessment tool: Review and summary of the evidence

Inpatient management of complicated mTBI with the BIG assessment tool: Review and summary of the evidence

Isolated LOC in head trauma associated with significant injury on brain CT scan

Concussion management in the ED: Beyond GCS

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