Emergency Department Evaluation of Traumatic Brain Injury in the United States, 2009-2010.
Frederick K Korley, Gabor D Kelen, Courtney M Jones and 1 others
PMID 26360006WHAT IT FOUND
Most US emergency visits evaluated for brain injury result in a head CT scan, but 91% of those scans show no traumatic abnormality.
This high volume of negative scans suggests a need for better triage tools to reduce unnecessary radiation and cost.
Key findings
01An estimated 82% of patients evaluated for traumatic brain injury in US emergency departments receive a head CT scan.
02Among those who received a head CT, only 9% had evidence of traumatic abnormalities, meaning 91% of scans were negative for such findings.
03The majority of patients evaluated for traumatic brain injury can be classified as having mild injury, regardless of whether severity is assessed by Glasgow Coma Scale or Abbreviated Injury Scale.
STILL TO COME
How it was doneWhat they found
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What it does not show
The study relies on ICD-9 codes and chart abstractions, which may underestimate the true burden of TBI diagnosis. Head CT scans were not performed in all patients evaluated for TBI, potentially missing those with injuries who did not undergo imaging. GCS was not documented in 57.2% of patients, and Head AIS scores could not be calculated for 43.2% due to missing code digits. The data is from 2009-2010, so current practice patterns may differ. The study describes the population evaluated but does not assess the accuracy of the evaluations themselves.
Declared interests
The study protocol was approved by the Johns Hopkins University School of Medicine. NHAMCS is conducted by the CDC's National Center for Health Statistics. No specific funding or conflict of interest declarations are provided in the text beyond the source of the survey data.
The easy way to misread this
Do not interpret the high rate of negative head CT scans as evidence that these scans are always unnecessary or that patients with negative scans have no brain injury. The study notes that clinical interview and CT have limited sensitivity, and some patients with negative CTs may still have mild TBI or other conditions requiring care.