Objective: Identify patients with specific emergency department (ED) discharge diagnoses who later report symptoms associated with a mild traumatic brain injury (MTBI), compare frequency and severity of MTBI symptoms by discharge diagnoses, investigate the frequency of head injury education provided to ED patients with each diagnosis, and finally, to learn what type of changes have occurred in the lives of patients as a result of their injury.
Methods: Fifty-two ED patients, aged 18 to 28 who were at least two weeks post injury, spoke English and were discharged with a diagnosis of concussion/closed head injury (CHI), head laceration, motor vehicle crash (MVC), whiplash/cervical strain, facial/jaw fractures or multiple injuries were invited to participate. Participants completed the Post Concussive Symptom Scale (PCSS), a demographic questionnaire and then a series of open-ended questions about the impact the injury had on their lives.
Results: MTBI symptoms on the PCSS were reported by 84.6% (n = 44) of respondents with a range of 1 – 23 different symptoms per participant. Headache (69.2%) and fatigue (61.5%) were the most common symptoms. Males (51% of the participants) reported on average 6.76 symptoms (S.D. = 6.53) whereas females reported an average of 12.68 symptoms (S.D. = 6.32). A large percentage (83.3%, n = 10) of participants with a MVC diagnosis reported severity scores in the moderate range (mean = 3.17; S. D. = 0.27) in all four PCSS categories (physical, thinking, sleep and emotional) representing the highest severity scores reported overall. Participants diagnosed with a concussion/CHI received the most (74%) head injury education of all discharge diagnoses, but only half (51%) received written information. The most common quality of life change was that 70.3% of survey participants became more cautious.
Conclusion: Participants with a discharge diagnosis not commonly associated with brain injury reported having MTBI symptoms at least two weeks post injury with females reporting twice as many symptoms as males reported. Head injury education provided in the ED was lacking for all participants and although participants involved in a MVC reported having the most severe MTBI symptoms they had the least head injury education. All health care providers, especially nurses working in the ED, need to look beyond physical complaints and recognize injuries associated with increased risk for developing MTBI symptoms. Proactive ED identification of patients with "at risk" injuries by nurses would likely promote increased MTBI education and thereby result in fewer missed MTBI diagnoses.
College and Department
BYU ScholarsArchive Citation
Stuart, Barbara Kay, "Mild Traumatic Brain Injury: Are Emergency Department Providers Identifying Which Patients Are At Risk?" (2010). All Theses and Dissertations. 2443.
Mild traumatic brain injury, identification, symptoms, treatments, education, outcomes, quality of life