Abstract
Mild traumatic brain injury (mTBI) affects millions of Americans each year. Lack of consistent clinical practice raises concern that many patients with mTBI may not receive adequate follow-up care. To characterize the provision of follow-up care to patients with mTBI during the first 3 months after injury. This cohort study used data on patients with mTBI enrolled in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study between February 26, 2014, and August 25, 2016. We examined site-specific variations in follow-up care, the types of clinicians seen by patients receiving follow-up care, and patient and injury characteristics associated with a higher likelihood of receiving follow-up care. The TRACK-TBI study is a prospective, multicenter, longitudinal observational study of patients with TBI presenting to the emergency department of 1 of 11 level I US trauma centers. Study data included patients with head trauma who underwent a computed tomography (CT) scan within 24 hours of injury, had a Glasgow Coma Scale score of 13 to 15, were aged 17 years or older, and completed follow-up care surveys at 2 weeks and 3 months after injury (N = 831). Follow-up care was defined as hospitals providing TBI educational material at discharge, hospitals calling patients to follow up, and patients seeing a physician or other medical practitioner within 3 months after the injury. Unfavorable outcomes were assessed with the Rivermead Post Concussion Symptoms Questionnaire. Of 831 patients (289 [35%] female; 483 [58%] non-Hispanic white; mean [SD] age, 40.3 [16.9] years), less than half self-reported receiving TBI educational material at discharge (353 patients [42%]) or seeing a physician or other health care practitioner within 3 months after injury (367 patients [44%]). Follow-up care varied by study site; adjusting for patient characteristics, the provision of educational material varied from 19% to 72% across sites. Of 236 patients with a positive finding on a CT scan, 92 (39%) had not seen a medical practitioner 3 months after the injury. Adjusting for injury severity and demographics, patient admission to the hospital ward or intensive care unit, patient income, and insurance status were not associated with the probability of seeing a medical practitioner. Among the patients with 3 or more moderate to severe postconcussive symptoms, only 145 of 279 (52%) reported having seen a medical practitioner by 3 months. There are gaps in follow-up care for patients with mTBI after hospital discharge, even those with a positive finding on CT or who continue to experience postconcussive symptoms.
Highlights
Traumatic brain injury (TBI) is a critical global public health issue
Follow-up care varied by study site; adjusting for patient characteristics, the provision of educational material varied from 19% to 72% across sites
This type of injury affects millions of Americans each year, resulting in approximately 2.5 million emergency department (ED) visits in 2013.1 Of brain injuries among patients presenting to the ED, most are classified as mild TBI or concussion, defined by an initial Glasgow Coma Scale (GCS) score of 13 to 15.2,3 Despite the classification of mild, mTBI can lead to persistent physical, neuropsychiatric, and cognitive symptoms that have a major impact on function and quality of life of the injured patient.[4,5,6,7]
Summary
Traumatic brain injury (TBI) is a critical global public health issue This type of injury affects millions of Americans each year, resulting in approximately 2.5 million emergency department (ED) visits in 2013.1 Of brain injuries among patients presenting to the ED, most are classified as mild TBI (mTBI) or concussion, defined by an initial Glasgow Coma Scale (GCS) score of 13 to 15.2,3 Despite the classification of mild, mTBI can lead to persistent physical, neuropsychiatric, and cognitive symptoms that have a major impact on function and quality of life of the injured patient.[4,5,6,7] In a recent report from the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study, 22% of patients with mTBI remained functionally impaired 1 year after the injury.[4] While data on the cost of mTBI are limited, one estimate suggests that mTBI is associated with as much as a 75% increase in expected medical costs up to 3 years after injury,[8] and there is growing evidence that the sequelae of TBI may contribute to loss of employment, homelessness, and incarceration.[9,10,11]. More than 60% of a sample of patients that included both those with mTBI and those with moderate to severe TBI (GCS score of 3-15) received no additional services following discharge from the acute care hospital in the late 1990s.19 Failure to follow up with patients could have adverse consequences, as providing educational materials to patients with mTBI is associated with improved outcomes.[20,21,22]
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