June 27, 2018
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Follow-up care for mild brain injury lacking, study shows

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Patients with mild traumatic brain injury may not receive adequate follow up-care in spite of experiencing debilitating postconcussive symptoms, according to a study.

The TRACK-TBI study surveyed patients with mild traumatic brain injury (mTBI), Glasgow Coma Scale Score (GCS) of 13 to 15 and diagnosed by head computed tomography at one of 11 level I U.S. trauma centers. A total of 1,316 patients were evaluated, and 831 completed the 2-week and 3-month follow-up, which included questions on the care received after discharge. They also completed questionnaires on physical and psychological symptoms associated with postconcussion syndrome (PCS).

Less than half of the patients reported seeing a medical practitioner at 2 weeks and 3 months or receiving TBI educational material at discharge. There was a wide site-specific variation, with better rates in sites with specialty TBI clinics. Of the 273 patients who saw a physician at 3 months, 218 saw a general practitioner, and 38% saw a neurologist. Only 15% reported visiting specialized TBI clinics.

More frequent follow-up care was associated with injury severity and with some demographic characteristics, such as female gender and non-Hispanic white ethnicity, while no association was found with age, income and insurance status.

The authors expressed concern about the low rates and inconsistency of follow-up care provided to these patients. Many patients reported persistent PCS symptoms, such as headache, dizziness, nausea and sleep disturbances, as well as symptoms of psychological distress such as depression and anxiety.

“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,” the authors noted. “The finding that 48% of patients with significant postconcussive symptoms (134 of 279) were not seen by a medical practitioner by 3 months underscores the need to improve the system of care for mTBI and concussion,” they wrote. – by Michela Cimberle

Disclosure: Seabury reported grants from the National Institute of Neurological Disorders and Stroke and grants from Research to Prevent Blindness during the conduct of the study and personal fees from Precision Health Economics outside the submitted work. Please see the study for the other authors’ financial disclosures.