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New Study Asks: How Do Emergency Rooms Evaluate Traumatic Brain Injury?

According to data by the Centers for Disease Control (CDC), 2.5 million people visit emergency rooms annually for a traumatic brain injury (TBI). Personally, I think the number of actual TBI cases in our emergency rooms is much higher than documented. Why do I think this? Some patients in the ER have multiple injuries from trauma. Take an injured victim of a car accident for example. When the car accident victim arrives at the emergency room, medical personnel check for life-threatening internal injuries, spinal injuries and other fractures. Unless the person has visible head trauma or obvious symptoms of head injury, that issue may be neglected. Many cases of mild head injury are ignored. Many TBI victims look normal.

In other cases, emergency rooms simply lack the detailed testing needed to detect cases of mild traumatic brain injury. In those situations, the X-ray or CT may appear normal even though the person suffers a significant TBI.

A recent Forbes article notes the lack of consistency by emergency rooms in diagnosing TBI. According to the article:

While some patients will end up being diagnosed with concussions after their initial ED visit, the reality is that there currently is not a comprehensive or even standardized approach in the ED for patients who suffer a TBI.

As a result, many patients go undiagnosed and untreated. This is a problem I see frequently in my practice. Medical personnel need a better and standardized protocol to evaluate possible head injuries just as they have with other conditions.

Because some cases of brain injury develop slowly following the trauma, it is likely a certain segment of injuries will still be missed. However, emergency rooms could do much better in documenting and diagnosing cases of brain injury. Early documentation and evaluation are critical for several reasons. Early evaluation allows rehabilitation to start sooner so the injured person can return to work and other activities. Early treatment increases the chances of a full recovery. Early treatment decreases overall costs of long-term lost employment. Early treatment allows affected families to understand sooner the injured person’s changes in cognitive function, emotion or memory. In the legal context, early evaluation provides better documentation of the injury and establishes a clearer picture of the accident as its cause.

In a current study, researchers are working on a more consistent and uniform approach to diagnose TBI in emergency rooms. The goal of the researchers:

Their goal is to develop a multimodal approach to brain injury for use in the future, similar to the way a patient with chest pain presents to the emergency department and has a battery of tests including an EKG, blood work and possibly even a coronary CT angiogram or an echocardiogram.

The researchers’ aim is to develop a new standard approach for evaluating patients with a TBI in the ED, which will include blood-based biomarkers and eye-tracking technology to assess how well the brain is working, along with specialized imaging and cognitive evaluations to better detect early signs of concussion and allow for earlier treatment and referral. Detecting abnormalities earlier will better allow physicians to improve outcomes after a TBI, according to the researchers.

Emergency rooms should develop a standard protocol for potential TBI patients. In addition to establishing a consistent protocol, the researchers appear to be implementing better testing and evaluation methods. The present emergency room system often employs tests that are not even sufficiently detailed to evaluate cases of mild traumatic brain injury. Hopefully, this study will eventually bring needed changes in the field of traumatic brain injury.