Frequency of factors that complicate the identification of mild traumatic brain injury in level I trauma center patients

Abstract

Aim Determine the frequency of factors that complicate identification of mild traumatic brain injury (mTBI) in emergency department (ED) patients. Setting Chart review. Materials & Methods Records of 3,042 patients (age 18-45) exposed to a potential mechanism of mTBI were reviewed for five common complicating factors and signs of mTBI. Results Most patients (65.1%) had at least one complicating factor: given narcotics in the ED (43.7%), on psychotropic medication (18.4%), psychiatric diagnosis (15.3%), alcohol consumption near time of admission (14.2%), and pre-admission narcotic prescription (8.9%). Conclusion Our findings highlight the frequency of these confounding factors in this population. Future research should identify how these factors interact with performance on assessment measures to improve evidence-based mTBI assessment in this population.

Acute Clinical Predictors of Symptom Recovery in Emergency Department Patients with Uncomplicated Mild Traumatic Brain Injury or Non-Traumatic Brain Injuries

“…Alternatively, this could reflect sampling/measurement issues. For example, given the relative heterogeneity of ED versus athlete subjects, [65][66][67] it could be the case that the greater variance on neurocognitive performance measures (or higher base rates of neurocognitive impairment) in the ED sample yielded increased statistical power to detect effects of these measures. Similarly, LOC (and other acute injury characteristics), although predictive in this sample, has not consistently predicted clinical outcomes in other studies.…”

Prospective, Head-to-Head Study of Three Computerized Neurocognitive Assessment Tools Part 2: Utility for Assessment of Mild Traumatic Brain Injury in Emergency Department Patients

“…A major factor that complicates the identification of mTBI in ED and other civilian mTBI populations is the high prevalence of comorbid personal and clinical features that mimic the effects of mTBI, thereby rendering it difficult to isolate the effects of the injury (Furger, Nelson, Lerner, & McCrea, 2016; Luoto et al, 2013; Mathias, Harman-Smith, Bowden, Rosenfeld, & Bigler, 2014). To the degree that neurocognitive tests are sensitive to mTBI in ED patients, their use could facilitate its identification and the triaging of affected patients into appropriate education and clinical management opportunities.…”

Characteristics of patients included and enrolled in studies on the prognostic value of serum biomarkers for prediction of postconcussion symptoms following a mild traumatic brain injury: a systematic review

“…The diagnostic criteria can be unreliable and overlap many conditions such as dementia, delirium or intoxication, and the presence of confounding factors during the initial assessment is frequent. 8 …”

“… 3 However, there is still an incomplete understanding of mTBI pathophysiology that leads to suboptimal diagnosis, treatment and prognostication. 4 With increasing attendance to emergency departments following mTBI by complex patients such as elderly, 5 intoxicated patients 6 7 and patients with psychiatric disorders, 8 there is an urgent need to optimise the care of patients with mTBI.…”