Discrepancy between the initial assessment of injury severity and post hoc determination of injury severity in patients with apparently mild traumatic brain injury: a retrospective multicenter cohort analysis

Abstract

PurposeTraumatic brain injury (TBI) is a major cause of trauma-related visits to emergency departments (ED). Determination of monitoring requirements of patients with apparently mild TBI is challenging. Patients may turn out to be more severely injured than initially assumed, and failure to identify these patients constitutes a serious threat to patient safety. We, therefore, aimed to identify clinical risk factors for more severe injuries in patients with apparently mild TBI.MethodsIn a retrospective cohort analysis performed at two level I trauma centers, 808 patients aged ≥ 16 presenting to the ED with head trauma and a Glasgow Coma Scale (GCS) score 13–15 who received a head CT scan were studied. Discrepancies between the initial TBI severity as determined by GCS and severity as determined post hoc by the Head Abbreviated Injury Score were assessed. Multiple logistic regression was used to identify risk factors of such discrepancies.Results104 (12.9%) patients were more severely injured than initially classified. A GCS < 15 at presentation (GCS 13: OR 6.2, [95% CI 3.8–9.9]; GCS 14: OR 2.7, [2.0–3.7]), an SpO2 < 90% (OR 5.4, [1.2–23.4]), loss of consciousness (OR 2.3, [1.5–3.5]), absence of equal and reactive pupils (OR 2.1, [1.6–2.7]), transport by ambulance (OR 2.0, [1.7–2.4]), and use of anticoagulant drugs (OR 1.2, [1.1–1.3]) were independent risk factors of more severe injury.ConclusionsSix risk factors of more severe injury in patients presenting with apparently mild TBI were identified. Patients with any of these factors should be thoroughly monitored for signs of neurologic deterioration.

The influence of the COVID-19 pandemic on traumatic brain injuries in Tyrol: experiences from a state under lockdown

“…Corresponding to our findings, the risk of ground level falls resulting in TBI is known to be rising with age [31,32]. Reason for this are mostly trivial falls (from furniture or from tripping/stumbling) due to multifactorial unsteady gait or polypharmacological therapy [7,33]. But despite a massive increase in people staying at home and reduction of daily activities, we did find a relatively unchanged incidence in low-impact falls, despite age of TBI being the highest during the quarantine period.…”

Diagnostic value of emergency medical services provider judgement in the identification of head injuries among trauma patients

“…Previous studies showed that the vital signs are often not affected and may change over time. Patients suffering a head injury from low‐risk mechanisms of injury might present to the EMS providers with minimal symptoms, but develop alarming symptoms hours or days later . In this study, most patients with a head injury had a Glasgow Coma Scale (GCS) score between 12 and 15.…”

Computed Tomography Lesions and Their Association With Global Outcome in Young People With Mild Traumatic Brain Injury

“…Covariables were selected based on previous literature and clinical reasoning. [24][25][26][27] Regressions were performed on the multiply-imputed datasets, and effect estimates were subsequently pooled according to Rubin's rules. 28 Odds ratios and their 95% confidence intervals are reported.…”