Emergency Department Time Course for Mild Traumatic Brain Injury Workup

The Western Journal of Emergency Medicine
Edward A MichelsonAriel Berger

Abstract

Mild traumatic brain injury (mTBI) is a common cause for visits to the emergency department (ED). The actual time required for an ED workup of a patient with mTBI in the United States is not well known. National emergency medicine organizations have recommended reducing unnecessary testing, including head computed tomography (CT) for these patients.10. To examine this issue, we developed a care map that included each step of evaluation of mTBI (Glasgow Coma Scale Score 13-15) - from initial presentation to the ED to discharge. Time spent at each step was estimated by a panel of United States emergency physicians and nurses. We subsequently validated time estimates using retrospectively collected, real-time data at two EDs. Length of stay (LOS) time differences between admission and discharged patients were calculated for patients being evaluated for mTBI. Evaluation for mTBI was estimated at 401 minutes (6.6 hours) in EDs. Time related to head CT comprised about one-half of the total LOS. Real-time data from two sites corroborated the estimate of median time difference between ED admission and discharge, at 6.3 hours for mTBI. Limiting use of head CT as part of the workup of mTBI to more serious cases may reduce time spent in t...Continue Reading

References

Jul 13, 2000·The New England Journal of Medicine·M J HaydelP M DeBlieux
Nov 26, 2008·Annals of Emergency Medicine·Andy S JagodaUNKNOWN Centers for Disease Control and Prevention
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May 11, 2017·The American Journal of Emergency Medicine·Jonathan G RoggBenjamin A White

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brain injury after impact to the head is due to both immediate mechanical effects and delayed responses of neural tissues.

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