MILD TRAUMATIC BRAIN INJURIES IN LOW-RISK TRAUMA PATIENTS

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.