Factors associated with unplanned emergency department return visits after mild traumatic brain injury

Mild traumatic brain injuries (mTBI) account for millions of emergency department (ED) visits annually. Persistent symptoms may prompt unplanned return visits (URVs), but the frequency and associated factors remain unclear. This study examined whether patient characteristics, injury mechanism, clinical workflow, discharge instructions, and follow-up plans were associated with ED URVs.

We conducted a retrospective chart review of patients presenting with mTBI to a suburban academic hospital. Exclusions included psychiatric illness, positive findings on diagnostic head imaging, or impaired capacity. The primary outcome was an URV related to the index injury within 8 weeks. Data collected included demographics, injury mechanism, provider type, imaging, EPIC-created pre-populated patient education handout, and follow-up plans. Uni- and multivariate analyses were performed.

Among 733 unique visits, the URV rate was 10.9%. URV rates did not differ by head imaging status (p = 0.708), referral for follow-up (p = 0.978), or practitioner level (p = 0.840). Common injury mechanisms included falls (41.0%), unintended contact with an object (30.2%), and sports-related injuries (14.5%). Patients who received educational handouts had lower URV rates than those who did not (p = 0.016). After adjustment for demographic factors, receipt of pre-populated educational handouts remained associated with lower odds of URV.

Approximately 1 in 10 patients with mTBI had UVRs. While clinical workflow factors, imaging, and referrals were not associated with URVs, disparities by ethnicity and differences by injury mechanism were observed. Educational handouts were independently associated with URV. Enhancing patient education and anticipatory guidance may reduce URVs and improve equity in post-mTBI care.