J. Chambers et al., MILD TRAUMATIC BRAIN INJURIES IN LOW-RISK TRAUMA PATIENTS, The journal of trauma, injury, infection, and critical care, 41(6), 1996, pp. 976-980
Background: Moderate or severe traumatic brain injury (TBI) resulting
from cranial trauma is usually easily recognizable, Mild TBI (MTBI), h
owever, may escape detection at presentation because of delayed sympto
ms and the absence of radiographic abnormalities, Despite its subtle o
r delayed presentation, the spectrum of symptoms often experienced aft
er MTBI, collectively referred to as ''postconcussive syndrome,'' may
cause serious psychosocial dysfunction. Methods/Results: To assess the
sensitivity of emergency department screening for MTBI, a prospective
follow-up study was conducted on a group of patients (N = 129) who ha
d been evaluated at a regional trauma center after blunt trauma, None
had symptoms or signs of TBI at presentation, nor any history of direc
t cranial trauma, All were discharged to home from the emergency depar
tment without a diagnosis of TBI, At 1 month after injury, 41 of 129 (
32%) patients described an increase in symptoms consistent with MTBI.
The most common symptoms were insomnia (62%), headaches (58%), irritab
ility (56%) and fatigue (56%). At 2 months, most symptoms had decrease
d significantly, and none had increased in severity. Despite improveme
nt in their symptoms over that time period, 11% of those with persiste
nt symptoms remained unable to resume their premorbid daily activities
, Conclusions: These data, obtained from a population of patients cons
idered to be at extremely low risk for TBI, indicate that MTBI occurs
more often among blunt trauma patients than is commonly appreciated, e
ven in busy trauma centers. Because early recognition of MTBI may expe
dite referral of these patients for appropriate outpatient follow-up c
are, thereby avoiding potentially serious social and financial repercu
ssions, emergency department personnel should have a high index of sus
picion for MTBI in any patient sustaining blunt systemic trauma. Curre
nt measures that screen for MTBI appear to be inadequate; follow-up pr
otocols may prove to be more sensitive screening tools.