Mild traumatic brain injury: key decisions in acute management

The definition of a mild traumatic brain injury (TBI) has come under close scrutiny and is changing as a result of refined diagnostic testing. Although up to 15% of patients with a mild TBI will have an acute intracranial lesion identified on head computed tomography (CT), less than 1% of these patients will have a lesion requiring a neurosurgical intervention. Evidence-based guideline methodology has assisted in generating recommendations to facilitate clinical decision making; however, no set of guidelines is 100% sensitive and specific. Evidence supports the safety of discharging patients with mild TBI who have a negative CT. However, though patients with a negative CT are at almost no risk of deteriorating from a neurosurgical lesion, a key intervention is to provide these patients at discharge from the emergency department with counseling regarding postconcussive symptoms, when to return to work, school, or sports, and when to seek additional medical care.