Evaluation and management of mild traumatic brain injury

An eastern association for the surgery of trauma practice management guideline

Ronald R. Barbosa, Randeep Jawa, Jennifer Watters, Jennifer C. Knight, Andrew J. Kerwin, Eleanor S. Winston, Robert D. Barraco, Brian Tucker, James M. Bardes, Susan Rowell

    Research output: Contribution to journalArticle

    39 Citations (Scopus)

    Abstract

    BACKGROUND: An estimated 1.1 million people sustain a mild traumatic brain injury (MTBI) annually in the United States. The natural history of MTBI remains poorly characterized, and its optimal clinical management is unclear. The Eastern Association for the Surgery of Trauma had previously published a set of practice management guidelines for MTBI in 2001. The purpose of this review was to update these guidelines to reflect the literature published since that time. METHODS: The PubMed and Cochrane Library databases were searched for articles related to MTBI published between 1998 and 2011. Selected older references were also examined. RESULTS: A total of 112 articles were reviewed and used to construct a series of recommendations. CONCLUSION: The previous recommendation that brain computed tomographic (CT) should be performed on patients that present acutely with suspected brain trauma remains unchanged. A number of additional recommendations were added. Standardized criteria that may be used to determine which patients receive a brain CT in resource-limited environments are described. Patients with an MTBI and negative brain CT result may be discharged from the emergency department if they have no other injuries or issues requiring admission. Patients taking warfarin who present with an MTBI should have their international normalized ratio (INR) level determined, and those with supratherapeutic INR values should be admitted for observation. Deficits in cognition and memory usually resolve within 1 month but may persist for longer periods in 20% to 40% of cases. Routine use of magnetic resonance imaging, positron emission tomography, nuclear magnetic resonance, or biochemical markers for the clinical management of MTBI is not supported at the present time.

    Original languageEnglish (US)
    JournalJournal of Trauma and Acute Care Surgery
    Volume73
    Issue number5 SUPPL.4
    DOIs
    StatePublished - Nov 2012

    Fingerprint

    Brain Concussion
    Practice Management
    Practice Guidelines
    Wounds and Injuries
    International Normalized Ratio
    Brain
    Warfarin
    PubMed
    Positron-Emission Tomography
    Cognition
    Libraries
    Hospital Emergency Service
    Magnetic Resonance Spectroscopy
    Biomarkers
    Magnetic Resonance Imaging
    Observation
    Databases
    Guidelines

    Keywords

    • concussion
    • guidelines
    • Mild traumatic brain injury

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine
    • Surgery

    Cite this

    Evaluation and management of mild traumatic brain injury : An eastern association for the surgery of trauma practice management guideline. / Barbosa, Ronald R.; Jawa, Randeep; Watters, Jennifer; Knight, Jennifer C.; Kerwin, Andrew J.; Winston, Eleanor S.; Barraco, Robert D.; Tucker, Brian; Bardes, James M.; Rowell, Susan.

    In: Journal of Trauma and Acute Care Surgery, Vol. 73, No. 5 SUPPL.4, 11.2012.

    Research output: Contribution to journalArticle

    Barbosa, Ronald R. ; Jawa, Randeep ; Watters, Jennifer ; Knight, Jennifer C. ; Kerwin, Andrew J. ; Winston, Eleanor S. ; Barraco, Robert D. ; Tucker, Brian ; Bardes, James M. ; Rowell, Susan. / Evaluation and management of mild traumatic brain injury : An eastern association for the surgery of trauma practice management guideline. In: Journal of Trauma and Acute Care Surgery. 2012 ; Vol. 73, No. 5 SUPPL.4.
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    AU - Watters, Jennifer

    AU - Knight, Jennifer C.

    AU - Kerwin, Andrew J.

    AU - Winston, Eleanor S.

    AU - Barraco, Robert D.

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