Accuracy of Mild Traumatic Brain Injury Diagnosis

• Published in: Archives of physical medicine and rehabilitation Vol. 89; no. 8; pp. 1550 - 1555
• Main Authors: Powell, Janet M., Ferraro, Joseph V., Dikmen, Sureyya S., Temkin, Nancy R., Bell, Kathleen R.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2008; Elsevier
• Subjects: Adult; Adult and adolescent clinical studies; Aged; Biological and medical sciences; Brain concussion; Brain Injuries - diagnosis; Cohort Studies; Craniocerebral trauma; Diagnosis-Related Groups - classification; Diseases of the osteoarticular system; Emergency Service, Hospital - statistics & numerical data; Female; Glasgow Coma Scale; Head injuries, closed; Humans; Injuries of the nervous system and the skull. Diseases due to physical agents; Male; Medical sciences; Middle Aged; Odds Ratio; Organic mental disorders. Neuropsychology; Physical Medicine and Rehabilitation; Post-concussive syndrome; Predictive Value of Tests; Prospective Studies; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Rehabilitation; Retrospective Studies; Sensitivity and Specificity; Trauma Centers - statistics & numerical data; Trauma Severity Indices; Traumas. Diseases due to physical agents; Washington; Washington; LOC; CDC; CHI; Brain concussion; CT; ICD-9-CM; Post-concussive syndrome; GCS; TBI; Rehabilitation; Craniocerebral trauma; PTA; Head injuries, closed; ED; computed tomography; closed head injury; traumatic brain injury; posttraumatic amnesia; emergency department; loss of consciousness; International Statistical Classification of Diseases, 9th Revision, Clinical Modification; Centers for Disease Control and Prevention; Glasgow Coma Scale; Nervous system diseases; Accuracy; Reeducation; Brain concussion; Craniocerebral trauma; Head injuries; Craniocerebral; Orthopedics; closed; Post-concussive syndrome; Rehabilitation; Diagnosis; Head trauma
• ISSN: 0003-9993; 1532-821X; 1532-821X
• DOI: 10.1016/j.apmr.2007.12.035

Powell JM, Ferraro JV, Dikmen SS, Temkin NR, Bell KR. Accuracy of mild traumatic brain injury diagnosis. To determine how often emergency department (ED) patients meeting the Centers for Disease Control and Prevention (CDC) mild traumatic brain injury (TBI) criteria were diagnosed with a mild TBI by the ED physician. Prospective identification of cases of mild TBI in the ED by study personnel using scripted interviews and medical record data was compared with retrospective review of ED medical record documentation of mild TBI. EDs of a level I trauma center and an academic nontrauma hospital. Prospective cohort of subjects (N=197; mean age, 32.6y; 70% men) with arrival at the ED within 48 hours of injury, Glasgow Coma Scale score of 13 to 15, and injury circumstances, alteration of consciousness, and memory dysfunction consistent with the CDC mild TBI definition. Not applicable. ED medical record documentation of mild TBI. Fifty-six percent of mild TBI cases identified by study personnel did not have a documented mild TBI-related diagnosis in the ED record. The greatest agreement between study personnel and ED physicians for positive mild TBI-related findings was for loss of consciousness (72% vs 65%) with the greatest discrepancy for confusion (94% vs 28%). The diagnosis of mild TBI was frequently absent from ED medical records despite patients reporting findings consistent with a mild TBI diagnosis when interviewed by study personnel. Asking a few targeted questions of ED patients with likely mechanisms of injury that could result in mild TBI could begin to improve diagnosis and, in turn, begin to improve patient management and the accuracy of estimates of mild TBI incidence.