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EDs Not Doing Enough to Ensure Follow-up After Mild TBI

Patients treated in 11 large trauma centers failed to get appropriate follow-up to mild traumatic brain injury (TBI). In fact, according to a recent study, many don’t even receive educational materials about their injury.

The authors of the article reported that in fewer than half of the 831 cases reviewed, patients received educational materials at discharge or went on to see clinicians for follow-up care. That was the case even for a meaningful percentage of patients with brain lesions or multiple post-concussive symptoms, the study authors noted.

Data used in the study was from the patients enrolled from 2014 to 2016 in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, which has collected detailed information, including CT/MRI imaging, blood biospecimens, and detailed clinical outcomes, for more than 2,700 brain injury patients from 18 different U.S. sites.

Follow-up care was defined as hospitals providing TBI educational materials at discharge, hospitals calling patients to follow-up, and patients seeing a physician or other clinician within three months of injury. Forty-seven percent of patients received educational materials about TBI at discharge, but only 44% followed up with a physician or other healthcare provider in a timely manner.

"The lack of follow-up after a concussion is concerning because these patients can suffer adverse and debilitating effects for a very long time," explained Seth Seabury, PhD, lead author and director of the Keck-Schaeffer Initiative for Population Health Policy at the University of Southern California. "Even patients who reported experiencing significant post-concussive symptoms often failed to see a provider. This reflects a lack of awareness, among patients and providers, that their symptoms may be connected to their brain injury."

Even in TBI cases classified as mild, patients can develop migraines, cognitive issues, vision loss, memory loss, emotional distress, or personality disorder, the study authors noted.

"For too many patients, concussion is being treated as a minor injury," argued Geoffrey Manley, MD, PhD, co-author and the principal investigator of the TRACK-TBI project. "This is a public health crisis that is being overlooked. If physicians did not follow up on patients in the emergency department with diabetes and heart disease, there would be accusations of malpractice."