The Experiences of People With Mild Traumatic Brain Injury Attending Emergency Departments in England

To establish the health care management experiences of people who had sustained a mild traumatic brain injury (mTBI) in the United Kingdom.

Interviews with people who had recently sustained a mTBI in the United Kingdom were conducted online using the platform Microsoft Teams and simultaneously digitally recorded and auto transcribed. Transcripts were cleaned and checked for accuracy before being subjected to inductive thematic analysis following the 6 phases outlined by Braun and Clarke.

Seventeen people with experience of mTBI and one carer participated in this study (n = 18 interviews). Three broad themes with 9 subthemes were generated. Themes mapped to the mTBI patient's health care journey accessing (prehospital), traversing (in-hospital) and exiting health care services (posthospital). Prehospital experiences were characterized by "Decisional Difficulty" (Theme 1); notably, there were challenges deciding whether symptoms were the result of an mTBI or preexisting disease, whether the mTBI was severe enough to warrant medical review, and which service was most appropriate to present to. In-hospital care was described as "Lacking Holism" (Theme 2) and participants voiced that there was a focus on the injury, not the person. Care was experienced as fragmented and discharge information and follow-up were frequently described as an afterthought. The posthospital recovery landscape was depicted as "Uncertainty Central" (Theme 3); uncertainties arose in part from the lack of information on recovery trajectories provided at discharge. Participants also described a desire for reassurance to help them navigate these uncertainties, and the need for work and home spaces that are sensitized to recovery.

The label mTBI has long been recognized as a misnomer given the significant debilitating impacts it can have in both the short and long term. This research describes patients' experiences of mTBI from a health care management perspective. It illuminates the suboptimal care pathways and management processes experienced by many. While there was staunch sympathy for health care providers and acknowledgement of the significant pressures they face, there is nevertheless a need for significant changes across primary, secondary, and tertiary care to ensure that the informational and care needs of people with mTBI are met. Greater public awareness in mTBI is also required, so that family members and other significant parties realize the scope of the impact. Finally, employment policies need to change to ensure that people with mTBI are supported in their recovery.