As the world enters year three of COVID-19, patients are returning to the Emergency Department (ED), with volumes approaching pre-pandemic levels. Among those returning are head-injured patients—an ED patient population that has increased 30% in recent years. Seventy percent of these patients are evaluated as treat and release, but many spend up to six hours in the ED because of typical assessment protocols.
When patients arrive at the emergency department (ED) with a suspected head injury, clinicians need to quickly assess for severity and determine next steps. Does the patient have a brain injury—brain bleed, concussion, or both? Understanding what happens to the brain following a head injury can help determine the next steps for assessment and treatment.
Head trauma, of varying degrees, affects millions of Americans each year and results in significant morbidity rates and substantial economic costs to society. According to the Brain Injury Alliance of Connecticut, someone in the United States sustains a traumatic brain injury (TBI) every twenty-one seconds. On average, this equates to approximately 2.5 million TBI-related emergency department visits per year. Mild TBI (mTBI) is the most common type of TBI, accounting for approximately 95% of patients evaluated in the emergency department (ED) for a head injury. MTBI generally is representative of patients who report mild, non-penetrating traumatic injury associated with a brief alteration in brain function. Although mTBI is often considered an incidental and non-threatening injury, severe short and long-term effects have long been established. Additionally, there is broad acceptance that multiple mTBIs can have serious, long-term consequences.
A traumatic brain injury (TBI) is caused by a bump or impact to the head that disrupts the brain's normal function. According to the CDC, most TBIs that occur each year are mild and sometimes called concussions. Mild traumatic brain injuries (mTBI) can cause changes in brain activity, leading to headaches, fatigue, disorientation, and irritability. A concussion is medically defined as a clinical syndrome characterized by immediate and transient alteration in brain function.