Evaluating Point-of-Care Electroencephalogram for Mild Traumatic Brain Injury Triage and Referral Pathways Within the...

Traumatic brain injuries, or TBIs, represent a common military health care system challenge due to the high frequency seen throughout the 21st century battlefield, workplace injuries, and other traumatic accidents. There is clear-cut guidance for the identification and treatment of moderate-to-severe TBIs, but most presentations are classified as mild. This quality improvement study evaluated whether incorporating a quantitative electroencephalogram (qEEG) device could improve triage accuracy, refine the referral pathway, and align mild TBI care with Defense Health Agency (DHA) recommendations within a military emergency department.

Investigators conducted a prospective cohort study with a secondary retrospective quality improvement analysis at a U.S. military treatment facility (MTF) emergency department (ED). One hundred patients with recent closed head injuries were evaluated using qEEG and calculated Brain Function Index (BFI) scores. Patients whose score correlated with a clinically significant brain injury (≤50) were referred to a TBI clinic. Patients with a score >50 were advised to follow up with their primary care provider (PCP). The primary objective was to evaluate the use of BFI scores to triage patients presenting with mild TBI to routine or TBI clinic follow-up, using descriptive statistics to compare their characteristics and assess factors associated with appropriate referral to the TBI clinic.

Patients in the TBI clinic group (n = 62) averaged a follow-up within 5 days and a return to duty within 20 days. The PCP group (n = 38) had a follow-up averaging 8 days and a return-to-duty of 9 days. In the PCP group, 10% were subsequently referred to a TBI specialist. Collectively, a total of 43 non-contrast head computed tomography scans were ordered: 48% in the TBI clinic group and 46% in the PCP group, all without significant abnormal findings.

Patients referred to TBI clinics had faster follow-up and less variability than the primary care group, suggesting a more efficient process for TBI-specific referrals that closely aligns with DHA recommendations. Ten percent of patients referred to primary care required referrals to TBI clinics, indicating appropriate identification and a low rate of missed referrals from the ED. Patients referred to TBI clinics had longer recovery times, reflecting that these clinics identify and address more complex cases and provide essential care.