The April, 2015 issue of The American Surgeon reports on a retrospective study of 395 patients admitted to the ER following concussions (MTBI, or mild traumatic brain injury). The patients had “normal” Glascow Coma scores of 15 and normal CT scans and therefore met discharge criteria. The study found that a surprisingly high percentage of these patients (27%) had persistent deficits after neurocognitive testing and benefitted from referral for ongoing therapy. The study is authored by Hartwell et. al. and entitled “You Cannot Go Home: Routine Concussion Evaluation is Not Enough.”
The authors report that in their Columbus, Ohio medical centers this study has led to “a heightened awareness of persistent MTBI symptoms” and to routine early neurocognitive screening of MTBI patients in the acute setting. The authors found no predictors of persistent symptoms that could be used in the ER setting other than neurocognitive testing – whether or not the patient had lost consciousness was of no predictive value. This study builds on prior authority, referenced in the report, that “up to 15 to 40 percent of patients will experience symptoms and report persistent deficits for a year or longer.” For these patients, early identification and early intervention is important to improve long term outcomes.
As previously discussed in this blog, there has been controversy in the past concerning whether or not persistent symptoms following concussion are physiological or only psychological. Scientific developments over the last several years (as also discussed in this blog) have left very little doubt that in a substantial subset of patients, a concussion leads to changes in the brain and that these changes can cause symptoms that persist and in some cases get worse over time. This new report highlights the importance of changing ER protocols to recognize this understanding, identify patients with neurocognitive deficits and provide appropriate early intervention.