Recognition of mTBI “Concussion” in the ED

It goes without saying Mild Traumatic Brain Injury (mTBI) is currently highly topical. Not a week goes by without some mention of it in the media, sadly, usually with a negative focus. It remains a difficult area of both Emergency and Sports Medicine. While a massive amount of time and attention is paid to it at an elite sporting level the same cannot be said for the wider population that present to the Emergency Department with concussive symptoms.

Around 1.4 million patients present to Emergency Departments each year with some form of head injury (40-50% are children). The severity of the head injuries varies but the vast majority fall into the category of mild. This seems like an alarming number; however, it likely grossly underestimates the problem. I’m sure we can all think of a time we took a knock playing sport, developed some dizziness or a headache etc. but didn’t seek medical attention!

Sadly, when patients do present to the ED, the assessment and advice they receive varies widely. The reasons for this are multi-factorial. Lack of experience from the attending physician. Rushed, busy departments leading to time restraints and in general there is no standardised approach to concussion assessment.

This obviously raises the question can we do better? Over the next few posts, I will look at the risks of failing to assess and treat mTBI. I will also share some work we have done at my Emergency Department to try to standardise mTBI assessment and advice following diagnosis.