Identification and Evaluation of Patients with Mild Traumatic Brain Injury: Results of a National Survey of Level I Trauma Centers

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Abstract
Mild traumatic brain injury (MTBI), alone or in combination with other injuries, is frequently present in trauma patients requiring hospital admission. A survey was conducted to characterize the current practices of identification and management of patients with MTBI at Level I trauma centers in the United States. Surveys were mailed to trauma program managers at 68 verified Level I trauma centers. Thirty-five (51.4%) centers responded, representing 24 states. Multiple terms are used synonymously with MTBI, and less than half (45%) of centers formally evaluate all trauma patients with MTBI. Patients identified with MTBI discharged from the emergency department are referred for further evaluation at only 34% of centers. There is no consistent practice for determining which hospitalized patients with MTBI are formally evaluated, who performs the evaluations, or which evaluation tool(s) are used. Patients with MTBI and cognitive deficits are referred to a variety of specialists after discharge. There is currently no standard practice for defining, evaluating, or managing MTBI at Level I trauma centers. A consistent definition of MTBI and its management could promote recognition of MTBI; facilitate data collection, analysis, and comparison; and provide guidelines for activity modification during recovery.