Introduction: The cost of mild traumatic brain injury (mTBI) is measurable by the over one million patients per year, the 15-30% suffering persistent symptoms, and the 16 billion dollars in yearly healthcare costs. In 2003, a CDC task force responded to this public health crisis, encouraging emergency department based studies to address the unknowns of mTBI including consensus definition, diagnostic criteria, and outcomes regarding functional impairment and disability. Few studies use clinical data to better understand the course and impact of mTBI, leading to a gap in knowledge of its natural history and ineffective interventions.

Methods: In a level 1 trauma department, patient data collected over a 5-year period was analyzed to select for blunt, non-penetrating head injury, with negative head CT and an Abbreviated Injury Scale (AIS) less than or equal to two. This subset, defined as mild head injury was then assessed based on the conceptual and operational definition criteria described in the 2003 CDC report. Follow-up data for approximately 90% of these patients was collected.

Results: 866 patients (age 15-95) met study criteria for mild head injury. 61% (n=527, 179 female, 348 male) suffered only head injury while 39% (n=339 109 female, 230 male) experienced head injury and other major injuries. The records of 813 patients were consistent with the conceptual definition of mTBI and provider’s most commonly documented level of consciousness (772 patients) followed by post-traumatic amnesia (97 patients). 46 patients met only the operational definition and 7 patients met neither definition. Of the conceptually and operationally defined, 293 patients were not admitted.

Conclusions: This study identifies trends in evaluation of mTBI in the trauma department and uses CDC recommendations to study follow-up, providing objective insight on the current state of care. Further follow-up data and clinical implications will be discussed.

Patient Care: This research will help providers to identify the minimum information necessary to track patients with mild traumatic brain injury. Sharing this data will encourage better tracking of mTBI patients, a crucial first step to prospective follow-up studies of mTBI-related disability and persisting symptoms. Identification of specific needs will lead to improved, patient-centered mTBI care, a crucial response to a large public health demand.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Recognize the utility and necessity of TBI registries to create prospective studies in order to characterize mTBI as a problem 2) Understand the problem of mTBI based on one hospital’s study of outcome and disability in a population of patients tracked according to recommended criteria 3) Create strategies for diagnosing, treating, and providing services to mTBI patients in hospital and outpatient settings.

References: United States. Center for Disease Control. Report to Congress on Mild Traumatic Brain Injury in the United States: Steps to Prevent a Serious Public Health Problem. 2003.