Emergency Department Evaluation of Traumatic Brain Injury in the United States, 2009–2010

Frederick Korley, Gabor D Kelen, Courtney M. Jones, Ramon Diaz-Arrastia

Research output: Contribution to journalArticle

Abstract

OBJECTIVE:: To determine the dimensions of traumatic brain injury (TBI) evaluation in US emergency department (EDs) to inform potential application of novel diagnostic tests. SETTING:: US EDs. PARTICIPANTS:: National Hospital Ambulatory Medical Care Survey of ED visits in 2009 and 2010 where TBI was evaluated (1) and diagnosed either clinically or (2) with head computed tomographic (CT) scans. DESIGN:: Retrospective cross-sectional. RESULTS:: TBI was evaluated during 4.8 (95% confidence interval [CI], 4.2-5.4) million visits per year; and head CT scan was performed in 82% of TBI evaluations (3.9 [95% CI, 3.4-4.4] million visits per year). TBI was diagnosed in 52% of evaluations (2.5 [95% CI, 2.1-2.8] million visits per year). Among those who received head CT scans, 9% had CT evidence of traumatic abnormalities. Among patients evaluated for TBI who had a Glasgow Coma Scale score recorded, 94.5% were classified as having mild TBI, 2.1% as moderate TBI, and 3.5% as severe TBI. Among patients with International Classification of Diseases, Ninth Revision, Clinical Modification, codes permitting the calculation of head Abbreviated Injury Scale scores 9.0%, 85.0%, 2.5%, 3.2%, 0.3%, and 0% had head Abbreviated Injury Scale scores of 1, 2, 3, 4, 5, and 6, respectively. Of patients evaluated for TBI, 31% had other head/face/neck injuries, 10% had spine and back injuries, 7% had torso injuries, and 14% had extremity injuries. CONCLUSION:: The ED is the main gateway to medical care for millions of patients evaluated for TBI each year. Novel diagnostic tests are needed to improve ED diagnosis and management of TBI.

Original languageEnglish (US)
JournalJournal of Head Trauma Rehabilitation
DOIs
StateAccepted/In press - Sep 10 2015

Fingerprint

Hospital Emergency Service
Head
Abbreviated Injury Scale
Confidence Intervals
Craniocerebral Trauma
Routine Diagnostic Tests
Traumatic Brain Injury
Brain Concussion
Back Injuries
Neck Injuries
Health Care Surveys
Torso
Glasgow Coma Scale
Wounds and Injuries
International Classification of Diseases
Patient Care
Spine
Extremities

ASJC Scopus subject areas

  • Rehabilitation
  • Clinical Neurology
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Emergency Department Evaluation of Traumatic Brain Injury in the United States, 2009–2010. / Korley, Frederick; Kelen, Gabor D; Jones, Courtney M.; Diaz-Arrastia, Ramon.

In: Journal of Head Trauma Rehabilitation, 10.09.2015.

Research output: Contribution to journalArticle

@article{fa3de031cbed49568590ca2abb495ef6,
title = "Emergency Department Evaluation of Traumatic Brain Injury in the United States, 2009–2010",
abstract = "OBJECTIVE:: To determine the dimensions of traumatic brain injury (TBI) evaluation in US emergency department (EDs) to inform potential application of novel diagnostic tests. SETTING:: US EDs. PARTICIPANTS:: National Hospital Ambulatory Medical Care Survey of ED visits in 2009 and 2010 where TBI was evaluated (1) and diagnosed either clinically or (2) with head computed tomographic (CT) scans. DESIGN:: Retrospective cross-sectional. RESULTS:: TBI was evaluated during 4.8 (95{\%} confidence interval [CI], 4.2-5.4) million visits per year; and head CT scan was performed in 82{\%} of TBI evaluations (3.9 [95{\%} CI, 3.4-4.4] million visits per year). TBI was diagnosed in 52{\%} of evaluations (2.5 [95{\%} CI, 2.1-2.8] million visits per year). Among those who received head CT scans, 9{\%} had CT evidence of traumatic abnormalities. Among patients evaluated for TBI who had a Glasgow Coma Scale score recorded, 94.5{\%} were classified as having mild TBI, 2.1{\%} as moderate TBI, and 3.5{\%} as severe TBI. Among patients with International Classification of Diseases, Ninth Revision, Clinical Modification, codes permitting the calculation of head Abbreviated Injury Scale scores 9.0{\%}, 85.0{\%}, 2.5{\%}, 3.2{\%}, 0.3{\%}, and 0{\%} had head Abbreviated Injury Scale scores of 1, 2, 3, 4, 5, and 6, respectively. Of patients evaluated for TBI, 31{\%} had other head/face/neck injuries, 10{\%} had spine and back injuries, 7{\%} had torso injuries, and 14{\%} had extremity injuries. CONCLUSION:: The ED is the main gateway to medical care for millions of patients evaluated for TBI each year. Novel diagnostic tests are needed to improve ED diagnosis and management of TBI.",
author = "Frederick Korley and Kelen, {Gabor D} and Jones, {Courtney M.} and Ramon Diaz-Arrastia",
year = "2015",
month = "9",
day = "10",
doi = "10.1097/HTR.0000000000000187",
language = "English (US)",
journal = "Journal of Head Trauma Rehabilitation",
issn = "0885-9701",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Emergency Department Evaluation of Traumatic Brain Injury in the United States, 2009–2010

AU - Korley, Frederick

AU - Kelen, Gabor D

AU - Jones, Courtney M.

AU - Diaz-Arrastia, Ramon

PY - 2015/9/10

Y1 - 2015/9/10

N2 - OBJECTIVE:: To determine the dimensions of traumatic brain injury (TBI) evaluation in US emergency department (EDs) to inform potential application of novel diagnostic tests. SETTING:: US EDs. PARTICIPANTS:: National Hospital Ambulatory Medical Care Survey of ED visits in 2009 and 2010 where TBI was evaluated (1) and diagnosed either clinically or (2) with head computed tomographic (CT) scans. DESIGN:: Retrospective cross-sectional. RESULTS:: TBI was evaluated during 4.8 (95% confidence interval [CI], 4.2-5.4) million visits per year; and head CT scan was performed in 82% of TBI evaluations (3.9 [95% CI, 3.4-4.4] million visits per year). TBI was diagnosed in 52% of evaluations (2.5 [95% CI, 2.1-2.8] million visits per year). Among those who received head CT scans, 9% had CT evidence of traumatic abnormalities. Among patients evaluated for TBI who had a Glasgow Coma Scale score recorded, 94.5% were classified as having mild TBI, 2.1% as moderate TBI, and 3.5% as severe TBI. Among patients with International Classification of Diseases, Ninth Revision, Clinical Modification, codes permitting the calculation of head Abbreviated Injury Scale scores 9.0%, 85.0%, 2.5%, 3.2%, 0.3%, and 0% had head Abbreviated Injury Scale scores of 1, 2, 3, 4, 5, and 6, respectively. Of patients evaluated for TBI, 31% had other head/face/neck injuries, 10% had spine and back injuries, 7% had torso injuries, and 14% had extremity injuries. CONCLUSION:: The ED is the main gateway to medical care for millions of patients evaluated for TBI each year. Novel diagnostic tests are needed to improve ED diagnosis and management of TBI.

AB - OBJECTIVE:: To determine the dimensions of traumatic brain injury (TBI) evaluation in US emergency department (EDs) to inform potential application of novel diagnostic tests. SETTING:: US EDs. PARTICIPANTS:: National Hospital Ambulatory Medical Care Survey of ED visits in 2009 and 2010 where TBI was evaluated (1) and diagnosed either clinically or (2) with head computed tomographic (CT) scans. DESIGN:: Retrospective cross-sectional. RESULTS:: TBI was evaluated during 4.8 (95% confidence interval [CI], 4.2-5.4) million visits per year; and head CT scan was performed in 82% of TBI evaluations (3.9 [95% CI, 3.4-4.4] million visits per year). TBI was diagnosed in 52% of evaluations (2.5 [95% CI, 2.1-2.8] million visits per year). Among those who received head CT scans, 9% had CT evidence of traumatic abnormalities. Among patients evaluated for TBI who had a Glasgow Coma Scale score recorded, 94.5% were classified as having mild TBI, 2.1% as moderate TBI, and 3.5% as severe TBI. Among patients with International Classification of Diseases, Ninth Revision, Clinical Modification, codes permitting the calculation of head Abbreviated Injury Scale scores 9.0%, 85.0%, 2.5%, 3.2%, 0.3%, and 0% had head Abbreviated Injury Scale scores of 1, 2, 3, 4, 5, and 6, respectively. Of patients evaluated for TBI, 31% had other head/face/neck injuries, 10% had spine and back injuries, 7% had torso injuries, and 14% had extremity injuries. CONCLUSION:: The ED is the main gateway to medical care for millions of patients evaluated for TBI each year. Novel diagnostic tests are needed to improve ED diagnosis and management of TBI.

UR - http://www.scopus.com/inward/record.url?scp=84944348239&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84944348239&partnerID=8YFLogxK

U2 - 10.1097/HTR.0000000000000187

DO - 10.1097/HTR.0000000000000187

M3 - Article

C2 - 26360006

AN - SCOPUS:84944348239

JO - Journal of Head Trauma Rehabilitation

JF - Journal of Head Trauma Rehabilitation

SN - 0885-9701

ER -