番茄社区

Most patients treated for mild traumatic brain injury (TBI) at level-one emergency departments did not see a clinician for follow-up care or receive educational materials at discharge, researchers for the TRACK-TBI study reported.

The Transforming Research and Clinical Knowledge in Traumatic Brain Injury () analysis showed that only 42% of patients with mild TBI received educational material when they were discharged from the emergency room and just 44% saw a physician or healthcare practitioner within 3 months after injury, according to Seth Seabury, PhD, of the University of Southern California in Los Angeles, and coauthors.

In addition, only 52% of patients who had three or more moderate to severe post-concussive symptoms saw a clinician by 3 months after discharge, they wrote in .

"This is a public health crisis that is being overlooked," co-author Geoffrey Manley, MD, PhD, of the University of California San Francisco, said in a statement.

"If physicians did not follow up on patients in the emergency department with diabetes and heart disease, there would be accusations of malpractice. For too many patients, concussion is being treated as a minor injury."

The low follow-up rates "most likely reflect poor coordination between acute and non-acute care settings," first author Seabury told 番茄社区.

"As a healthcare system, we need to do a better job of tracking patients after a concussion and ensuring they get the care that they need," he said. "While concussion has relatively low mortality risk, a number of patients will continue to experience post-concussive symptoms and disability for an extended period of time after their injury."

Mild TBI has been tied to cognitive dysfunction, depression, anxiety, fatigue, and post-concussion syndrome, plus long-term risks of dementia and . In an from TRACK-TBI researchers, 22% of patients with mild TBI still were functionally impaired 1 year after their injury. Few studies have investigated follow-up care after mild TBI, but prior research has shown that is associated with better outcomes.

TRACK-TBI is an ongoing prospective, longitudinal, observational study of TBI patients who present to the emergency department at one of 11 U.S. level-one trauma centers. For this analysis, researchers studied mild TBI patients from TRACK-TBI hospitals during 2015 to 2016 who had acute head trauma sufficient for an emergency department physician to order a clinical head computed tomography (CT) scan within 24 hours of injury.

Eligible patients had a Glasgow Coma Scale (GCS) score of 13 to 15 when they arrived at the emergency room, loss of consciousness for less than 30 minutes, and post-traumatic amnesia duration of less than 24 hours. At 2 weeks and 3 months, researchers surveyed patients about follow-up care and captured clinical outcome measures of physical and psychological symptoms.

Of 831 patients in the study, 58% were white, 65% were male and the average age was 40. More than half (59%) of the concussions resulted from traffic incidents; 24% were from falls and 6% from assaults.

The researchers found wide disparities across study sites; after adjusting for patient characteristics, providing TBI educational material varied from 19% to 72%, for example. Of 236 patients with a positive finding on their CT scan, 92 (39%) had not seen a medical practitioner 3 months after the injury. Among patients with 3 or more moderate to severe post-concussive symptoms, only 145 of 279 (52%) reported having seen a medical practitioner by 3 months.

Women (OR 1.44) and non-Hispanic white patients (OR 1.64) were more likely to have follow-up care by 3 months. Neither patient income nor insurance status was associated with receiving follow-up care. And patients admitted to the hospital ward or intensive care unit were no more likely to get follow-up care than those discharged directly from the emergency department.

"While recent media has focused on the important issue of repetitive brain injury among professional athletes, the cohort of individuals with mild traumatic brain injury who have been evaluated in the emergency department remains underappreciated," observed Mary Iaccarino, MD, of Massachusetts General Hospital, in an.

Post-concussive symptoms can produce a constellation of clinical challenges that may be difficult to treat, Iaccarino noted.

"In this population, early education and symptom-based treatment may be the best approach," she wrote. "For example, a recent study has suggested that an aggressive program of rest may not be helpful, and there is some evidence that activity-based therapies addressing symptom complexes offer benefit. In addition, multidisciplinary care seems to shine as a theme toward success."

Study limitations include small sample size, use of patient-reported data, heterogeneity of university-affiliated, level-one sites, and lack of multiyear follow-up. For these reasons, benefits of follow-up care and education only can be inferred, Iaccarino noted.

But despite these limitations,"this work is an important notation for next steps in understanding care needs and defining the phenotype of individuals who would most benefit from further education and integrated medical care."