Emergency Department Assessment of Mild Traumatic Brain Injury and Prediction of Persistent Post Concussion Symptoms
Mild traumatic brain injury (mTBI) is a commonly acquired neurological injury affecting thousands of Australians annually. The majority of patients sustaining mTBI report a range of post concussion symptoms during the first week of their injury including headaches, dizziness, fatigue, memory deficits, anxiety and depression. A significant proportion of those experiencing mTBI continue to report chronic symptoms. There is an ongoing need in the field for a brief, clinically based screen of mTBI that can be used in the acute setting to accurately predict individuals at high risk of PCS. This study investigated prediction of post concussion symptoms via an Emergency Department (ED) assessment examining neuropsychological and balance deficits and acute symptoms of a sample of individuals experiencing mTBI. Participants with minor orthopaedic injuries and ED visitors were recruited as control subjects. MTBI and orthopaedically injured participants were followed up by telephone at one and three months to assess symptom severity. In an earlier pilot study, the performance of 29 mTBI patients on some neurological tests was worse than that of 30 orthopaedically injured participants. The mTBI group also had decreased balance compared to 30 uninjured visitors in the ED and reported significantly more post-concussive symptoms at follow-up. Neuro-cognitive impairment, pain and balance deficits were all significantly correlated with severity of post concussion symptoms. The current study extends the pilot with a view to determining which combination of variables assessable in the ED is useful in predicting which individuals will suffer persistent post concussion problems. The ability to predict at risk individuals in the acute stage post injury would facilitate targeted early intervention and return to work, decreasing long-term morbidity and health care costs.