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Concussion Follow-Up Needs Work

June 21, 2018

Written by Clay Smith

Spoon Feed
We have much room for improvement in educating patients with mild traumatic brain injury (TBI) who are discharged from the ED on the importance of outpatient follow up.

Why does this matter?
Patients with mild TBI need outpatient follow up to monitor for worsening and to help guide them as they return to normal activities.  But are patients getting this follow up?

Brain sprain
This was a cohort of 831 patients over age 17 with mild TBI who had head CT, GCS 13-15, and were part of the TRACK-TBI study.  Only 42% said they received educational materials on TBI post-ED discharge and just 44% followed up with a provider within 3 months of the original head injury.  Positive CT findings were present in 236/831 (28%), and of these, only 61% followed up within 3 months of the index ED visit.  Strangely, insurance status was not associated with outpatient follow up.  This tells us we have room to improve on educating concussion patients about the importance of outpatient follow up.

Seabury SA et al. Assessment of follow-up care after emergency department presentation for mild traumatic brain injury and concussion: Results from the TRACK-TBI study. JAMA Network Open 2018 May 25; 1:e180210. (https://doi.org/10.1001/jamanetworkopen.2018.0210)

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Another Spoonful
emDocs has an excellent post on concussion, with a focus on care at the sideline, ED management, and even what happens after the ED with return to play.

Reviewed by Thomas Davis

What are your thoughts?