Original contributionConcussive Symptoms in Emergency Department Patients Diagnosed with Minor Head Injury
Introduction
Patients with minor head injury commonly present to the Emergency Department (ED). Minor head injuries are common in all age groups, accounting for 85% of all brain injuries (1). These injuries are debilitating and costly to the victims and to the medical care system (2, 3).
Clinical management of minor head injuries in the ED has been the subject of recent study (4). Efforts to improve ED treatment protocols for the head-injured patient include formulation of clinical decision rules to identify patients who require imaging, hospitalization, or neurosurgical intervention (5). In addition, consensus-based clinical practice guidelines for the management of minor head injuries in the ED have been developed (6). These initiatives focus on acute medical diagnosis, emergency treatment, and evidence-based decisions surrounding patient disposition (4, 5, 6). However, after acute and life-threatening events are ruled out, patients are often discharged without specific plans for follow-up care (4, 5, 6). Little is known about the disabling effects of minor head injuries seen in EDs beyond the acute medical encounter.
Epidemiological and neuropsychological studies suggest the persistence of a range of concussive symptoms in the weeks and months after minor head injury, including cognitive, physical, and emotional or behavioral effects (7, 8, 9, 10, 11, 12, 13). This evidence comes from the concussion literature and has been observed in patients in other clinical settings (e.g., sports medicine, neurology) (14, 15). In Canada, the annual incidence of patients who are treated in a hospital or clinic for minor head injury each year is 150 per 100,000 population (16). Similar annual rates have been reported for the United States (130 per 100,000), the United Kingdom (200–300 per 100,000), and for multiple countries by the World Health Organization (100–300 per 100,000, with higher rates among teenagers and adults) (16, 17, 18, 19, 20). The prevalence of reported post-concussive symptoms ranges from 34% to 84% in studies that followed patients for 3 months to 1 year (21, 22). Few clinical studies have investigated the frequency and severity of post-concussive symptoms in general populations of ED patients.
In this study, we prospectively followed a series of patients diagnosed with minor head injury who presented to the general EDs in Kingston, Ontario. Our objective was to describe the prevalence and patterns of concussive symptoms reported up to 1 month post-presentation.
Section snippets
Clinical Setting
The study population consisted of consecutive patients diagnosed with minor head injury (Glasgow Coma Scale [GCS] score of 15) presenting to either of the two EDs serving the city of Kingston, Ontario, Canada. Minor head injury was defined conceptually as any acute traumatic head injury with a transient loss of brain function (see operational definition below). Patients were enrolled at the Kingston General Hospital or Hotel Dieu Hospital between October 2005 and April 2006. Both are large,
Sample
There were 163 potential subjects identified during the recruitment period. Forty-one could not be contacted within 72 h, 8 had untraceable telephone numbers or addresses, 2 had language barriers that limited communication, and 10 refused participation. A total of 102 participants completed the baseline interview; of these, 8 were lost to follow-up at the second interview, leaving a total of 94 completed patient files. Table 1 describes demographic and injury-related characteristics of these
Discussion
The major finding from this prospective case series is that large proportions of patients discharged from EDs with a diagnosis of minor head injury continued to experience a range of concussive symptoms at 1 month post-injury. Most of these patients were discharged from the ED with no referral for follow-up care. Somatic symptoms of headache, fatigue, and dizziness were highest in frequency, and other types of cognitive and emotional symptoms persisted. Minor head injury, therefore, should be
Conclusion
This prospective case series demonstrates that most patients who present to the ED with minor head injury suffer from a range of concussive symptoms that do not resolve quickly. This fact may not be widely recognized by health care professionals who provide acute care to these patients. The high likelihood of ongoing concussive symptoms should be incorporated into discharge planning and instructions for these patients.
Acknowledgments
We thank Kathy Bowes and Fenni Loye of the Department of Emergency Medicine, Queen's University for data collection efforts.
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Recommendations for the Emergency Department Prevention of Sport-Related Concussion
2020, Annals of Emergency MedicineCitation Excerpt :If the sport-related concussion patient has already experienced concussions, the emergency physician should introduce the idea that continued exposure to head impacts might be dangerous for long-term neurologic health. Multiple studies have demonstrated variability or inadequacy of ED discharge instructions for patients with concussion,91-96 as well as poor compliance with recommendations.97,98 Discharge instructions have been shown to be maximally effective when they provide educational material about expected postconcussion symptoms, guidelines for return to activity, time-frame for follow-up, and recommendations for when to seek specialist care.96
Neurosensory diagnostic techniques for mild traumatic brain injury
2019, Neurosensory Disorders in Mild Traumatic Brain InjuryA population-based study of sport and recreation-related head injuries treated in a Canadian health region
2012, Journal of Science and Medicine in SportCitation Excerpt :This proportion is higher than that reported by a previous study in the same health region where 24% of HIs were due to SR-activities7; however, the present study included more severe HIs (i.e., haemorrhage). Other studies, which have limited inclusion to school aged children15 and minor head injuries16 have reported that 32% and 42% of HIs are due to SR-activities, respectively; however, direct comparisons between these studies are cautioned due to different inclusion criteria. A small number of SR-activities (e.g., hockey, cycling, skiing/snowboarding/sledding, soccer, and football) accounted for 59% of the SR-HIs treated in EDs.
Risk of suicide after a concussion
2016, CMAJCitation Excerpt :We distinguished each case as a weekend concussion (midnight Friday to midnight Sunday) or a weekday concussion (remaining 5 days and nights of the week).50 Differentiating a weekend from a weekday concussion was based on the date of medical care, which closely corresponds to the date of injury.51,52 For patients with multiple concussions, we used the date of the first concussion, such that each person was counted once in the analyses; repeat concussions were tracked for separate secondary analyses.
This study was supported by the Canadian Hospital Injury Reporting and Prevention Program (RJ Brison, Kingston medical director) funded by the Child Injury Section of the Public Health Agency of Canada; and the Ontario Neurotrauma Foundation (Grant # 2003-PREV-MS-03).