The Journal of Head Trauma Rehabilitation recently published an article entitled “Emergency Department Evaluation of Traumatic Brain Injuries in The United States, 2009-2010.” The article examined emergency department records from the national hospital ambulatory medical care survey in 2009 and 2010 where traumatic brain injury was evaluated and diagnosed either clinically or with head computed tomographic (CT) scans. A CT scan was performed on 82% of the TBI evaluations. Of those, only 9% had CT evidence of traumatic abnormalities.
The authors concluded the emergency department is the “primary gateway” to the medical system for patients with acute TBIs. However, emergency department evaluations have not been sufficiently described. This national study fills an important void.
First, although approximately 2.5 million ED patients are diagnosed with TBIs (as reported by recent CDC estimates), the number of ED patients evaluated for TBI is about twice that number, representing 3.6% of all ED visits. This finding suggests that ED evaluations for TBI present a substantial burden. Therefore the need for novel diagnostics to optimize the accuracy, efficiency and cost – effectiveness of these evaluations constitutes an important public health concern.
Another important consideration is that both the standard clinical interview and CT scans have limited sensitivity for diagnosing TBI. Thus, it is possible that a significant fraction of patients evaluated in the ED for TBI, who did not receive a diagnosis of TBI, did in fact sustain TBI.
This study is supported by the findings reported by Janet Powell, Ph.D. et al. in the Archives of Physical Medicine Rehabilitation. The article, entitled “Accuracy of Mild Traumatic Brain Injury Diagnosis,” reported that 56% of patients who had sustained a mild TBI were not diagnosed in the emergency room.
This new study provides further ammunition to attack defense courtroom doctors who deny the existence of TBI when it is not diagnosed in the ER.