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Do Emergency Rooms Fail to Diagnose Traumatic Brain Injury Victims?

Photo by Dierk Schaefer

Are traumatic brain injuries (TBI) being diagnosed by emergency rooms? It’s a topic of concern in our personal injury practice. We frequently help families struggling because a loved one suffers a TBI from an accident. We regularly see these injuries in both car accidents and work-related job site accidents. Traumatic brain injuries can drastically change the lives of individuals as well as entire families.

Early documentation and diagnosis are frequent issues in our TBI cases. Why do many TBI victims lack early diagnosis or treatment?¬†Initially, emergency rooms focus on immediate life-saving issues. A mild TBI may not be immediately life-threatening. Emergency rooms often neglect to document or diagnose broader cases of head trauma. This lack of documentation and care may continue beyond the initial ER visit. Later physicians are often inexperienced in mild traumatic brain injuries. These physicians may focus on the particular physical injury within their specialty while neglecting a TBI. Insurance companies also contribute to the problem with proper care. In workers’ compensation cases where the insurance company selects your doctors, insurers routinely ignore complaints. For insurance companies, it’s about saving money instead of providing care. These patients may never see a physician experienced or skilled with TBI issues.

The delayed diagnosis of TBI cases has two very bad effects. First, delays in diagnosis impact healing. Second, delays in diagnosis make it much more difficult to prove an accident caused your injury in court. Causation (did the accident cause your TBI) can become a huge issue in these cases.

Over the last year, we’ve written several posts about the diagnosis or treatment of TBI cases in emergency rooms. These posts include:

We’ve also written a number of other posts discussing the physical, mental and vocational impacts of TBI on patients. Research studies support what we have seen with our injured clients for years — Emergency rooms fail to document or diagnose many TBI cases. In one study, researchers studied two large urban hospitals. One of the hospitals was a Level I trauma center. These researchers also limited their study to individuals who arrived at the ER within the first 48 hours following a trauma. After studying these hospitals and following-up with patients, these researchers concluded the emergency rooms failed to diagnose over half of the patients suffering from a mild TBI. It’s important to remember “mild” is a medical term applicable to TBI but the lasting impacts of even a “mild” TBI can be life-changing. Even a mild TBI can be disabling. According to these researchers:

Fifty-six percent of mild TBI cases identified by study personnel did not have a documented mild TBI-related diagnosis in the ED [Emergency Room] record.

That’s a huge percentage of injured patients undiagnosed by the ER. I believe the percentage of missed cases is likely higher. Some patients suffering head trauma delay going to the ER. Those patients would be beyond the 48 hour limitation studied by these researchers. Researchers also discovered many of these patients could have been diagnosed by a few simple procedural changes in the ER. According to researchers:

The diagnosis of mild TBI was frequently absent from ED [Emergency Room] medical records despite patients reporting findings consistent with a mild TBI diagnosis when interviewed by study personnel.

I don’t write this as criticism of emergency room personnel. These medical professionals work exceptionally hard to save lives under difficult and stressful situations. However, I do believe the larger medical community should study emergency room procedures for documenting and diagnosing cases of mild TBI. Better documentation. Simply asking the right questions of patients. Routine blood tests. All these basic steps could improve the diagnosis of patients suffering TBI from an accident.