Washington, D.C. - The American College of Emergency Physicians in collaboration with the Centers for Disease Control and Prevention (CDC) have revised the clinical guidelines related to mild traumatic brain injuries in adult patients, which is expected to lead to better patient outcomes for the more than one million patients who visit the emergency department every year for mild traumatic brain injury (TBI), or concussion.

"People with traumatic brain injuries may appear to be normal and their symptoms may be mild, but there can be hidden dangers," said Richard C. Hunt, MD, Director of the Division of Injury Response at the Centers for Disease Control and Prevention.  "TBI's can also lead to significant, life-long impairments that prevent a person's ability to function both physically and mentally.  These revised guidelines can help ensure that patients with even mild TBI's are identified early and receive the care they need."

The real incidence of traumatic brain injury (TBI) is unknown since many patients who sustain an injury never seek medical care. The majority of these injuries are classified as mild, meaning the patient is alert, oriented and functional when they are assessed in the emergency department. It is estimated that 10 percent of patients with a mild TBI have evidence of an intracranial injury on head computed tomography (CT), and that approximately one percent of patients with mild TBI harbor a life-threatening neurosurgical lesion. The challenge for the emergency physician is to identify which patients with a head injury have an acute traumatic intracranial injury, and which patients can be safely sent home.

"The guidelines are written primarily for emergency physicians working in hospital-based emergency departments," said Andy Jagoda, MD, chair of the multidisciplinary panel that revised the 2002 clinical policy and Medical Director of the Department of Emergency Medicine at the Mount Sinai School of Medicine in New York. "However, we know that many patients with mild traumatic brain injury seek care from other practitioners such as internists, family practitioners, geriatricians, pediatricians and neurologists.  That's why it is critical that a broad range of health professionals become aware of the new guidelines."

Mild TBI results from direct trauma to the head or from an acceleration/deceleration stress to the brain. Mild TBI poses a risk for short-term difficulties with symptoms such as headache, difficulty with balance, thinking, concentrating and sleeping. Up to 80 percent of patients report some symptoms related to the injury at three months. Rarely, mild TBI may result in long-term problems, termed the post-concussive syndrome.

The new guidelines are available on ACEP's web site and in the December 2008 issue of the Annals of Emergency Medicine. They replace the initial clinical policy that was published in 2002. A template for emergency department discharge instructions to accompany these guidelines is expected to be released in the fall of 2009.

The revised clinical policy provides evidence-based recommendations on four issues that are key to the management of adult patients with mild TBI in the acute setting. The four key questions addressed in the revised clinical policy are:

• Which patients with mild TBI should have a non-contrast head CT scan in the emergency department?
• Is there a role for head MRI over non-contrast CT in the emergency department evaluation of a patient with acute mild TBI?
• In patients with mild TBI, are brain-specific serum biomarkers predictive of an acute traumatic intracranial injury?
• Can a patient with an isolated mild TBI and a normal neurologic evaluation result be safely discharged from the emergency department if a non-contrast head CT scan shows no evidence of intracranial injury?

"There are some important new findings in the field of TBI that physicians need to be aware of and the feedback we've been getting from experts in the field is that there is a real need for widespread dissemination and implementation of these guidelines in order to optimize patient care," says Dr. Jagoda "It's essential that these revised guidelines become part of medical education programs. There is also a potential benefit from incorporating these guidelines in electronic medical records."

For more information on the 2008 guidelines on MTBI, visit: http://www.acep.org/practres.aspx?id=30060.

For more information on traumatic brain injury (TBI), visit CDC on the Web at: www.cdc.gov/Injury.

 
ACEP is a national medical specialty society representing emergency medicine.  ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. 

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