Analysis of Mild Traumatic Brain Injury Outpatient Follow-Up
Sarah K West1, Brian Fletcher, Allison Rollins
1Division of Trauma and Acute Care Surgery, Grant Medical Center, OhioHealth, Columbus.
Background:
Mild traumatic brain injury (mTBI) remains a prevalent public health concern. Implementation of an mTBI guideline encouraged screening all patients at risk for mTBI, followed by outpatient follow-up in a "concussion clinic." This resulted in an increase in inpatient concussion evaluations, followed by high-volume referral to the concussion clinic. This prompted the routine use of an outpatient mTBI symptom screening tool. The purpose of this quality improvement study was to analyze the characteristics of an mTBI population at outpatient follow-up and describe the clinicians' care recommendations as determined through the use of an mTBI symptom screening tool.
Methods:
This is a retrospective review of mTBI patients at a Level 1 trauma center. The study includes patients who completed a concussion screening in the outpatient setting over a 6-month period. Patients were included if older than 16 years, sustained blunt trauma, and had a formal neurocognitive evaluation by a certified speech therapist within 48 hr of initial injury.
Results:
Of the 247 patients included, 197 (79.8%) were referred to the concussion clinic, 33 (13.4%) had no further outpatient needs, and 17 (6.9%) were referred for outpatient neurocognitive rehabilitation. On follow-up, 97 patients were deemed to have no further postconcussion needs by the trauma nurse practitioner; 57 patients were cleared by the speech therapist. In total, 43 outpatient mTBI follow-up encounters resulted in referral for ongoing therapy.
Conclusion:
Routine screening for concussion symptoms and detailed clinical evaluation allows for prompt recognition of further posttraumatic mTBI needs.
Insights
Routine outpatient screening effectively identifies patients needing further care after mild traumatic brain injury (mTBI). This approach ensures timely recognition of postconcussion needs and appropriate referrals for mild traumatic brain injury management.
Area of Science:
- Neuroscience
- Public Health
- Trauma Care
Background:
- Mild traumatic brain injury (mTBI) is a significant public health issue.
- Guidelines recommend screening at-risk patients, leading to increased evaluations and clinic referrals.
- Outpatient mTBI symptom screening tools are now routinely used.
Purpose of the Study:
- To analyze the characteristics of mTBI patients during outpatient follow-up.
- To describe clinician recommendations based on mTBI symptom screening tool data.
Main Methods:
- Retrospective review of mTBI patients at a Level 1 trauma center.
- Included patients >16 years with blunt trauma and neurocognitive evaluation within 48 hours.
- Data collected over a 6-month period from outpatient concussion screenings.
Main Results:
- 247 patients were included; 79.8% were referred to a concussion clinic.
- 13.4% required no further outpatient care, and 6.9% were referred for neurocognitive rehabilitation.
- 43 outpatient encounters resulted in referrals for ongoing therapy.
Conclusions:
- Routine screening for concussion symptoms aids prompt recognition of posttraumatic mTBI needs.
- Detailed clinical evaluation is crucial for identifying patients requiring further management.
- This process facilitates appropriate care pathways for mTBI patients.
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