Emergency Rooms can Miss Signs of Traumatic Brain Injury

Traumatic Brain Injury / Head Injury | emergency room | Traumatic Brain Injury

December 23, 2019

Brain Injury Survivor

The more things change, the more they stay the same—unfortunately.  In 2008, a study in the Archives of Physical Medicine and Rehabilitation found that over 50% of individuals with a mild traumatic brain injury[1] (mTBI) didn’t have it as a documented diagnosis from the emergency department.[2]    This was a dismaying finding at the time, but somewhat expected.  Only years prior, the CDC was referring to mTBI’s as the “silent epidemic” in a report to Congress.[3]  More resources and training were undoubtedly needed. 

A decade later, a second study was performed.[4]  Patients were admitted to a Level I trauma and emergency care center and asked the following two questions:

  • Did you hit your head or did your head move back and forward with a lot of force?; and
  • Did you have a change in mental status or level of consciousness as a result of the event (including fogginess, confusion, disorientation or the like)?[5]

The results were still troubling: only 15 out of the 98 patients who answered “yes” to these two questions were provided with discharge instructions related to brain injury.  And less than half were evaluated for a brain injury or had their symptoms documented at the emergency room.

What are the takeaways?  If someone you know is ever involved in a traumatic injury, check in with them frequently. Signs of mTBI don’t always show up immediately.  The first diagnosis and treatment may not include the complete story.  Know the signs and symptoms of mTBI, and keep an eye out for your family member, friend, or co-worker. They may not notice the changes in themselves, or they may be afraid to speak up. For example, watch out for headaches that don’t go away, or changes in mental status or awareness. Don’t just look for loss of consciousness, because they might never black out at all.

Now, this isn’t to suggest that just anyone should play doctor.  There are also other ways in which a mTBI can present itself. But making a medical referral to get checked out—or even just a suggestion to get help—can go a long way towards getting an injured person the access to care they need.  Time is often of the essence; the sooner a survivor can get appropriate care, the better their chance at a good recovery. 

To learn more on the signs and symptoms of mTBI, order a free copy of “Understanding Traumatic Brain Injury: A Guide for Survivors and Their Families” written by Richard H. Adler.  [link to order]


[1] “Mild” brain injury simply means the injury is not one that requires surgery to treat.

[2] Powell et al, Accuracy of Mild Traumatic Brain Injury Diagnosis, Archives of Physical Medicine and Rehabilitation (Vol. 89, August 2008).

[3] Julie Louise Gerberding and Sue Binder, Report to Congress on Mild Traumatic Brain Injury in the United States, Steps to Prevent a Serious Public Health Problem (September 2003).

[4] See Koval et al, Concussion Care in the Emergency Department: A Prospective Observational Brief Report, Annals of Emergency Medicine (2019).

[5] These questions reflect the CDC’s clinical definition of a mild traumatic brain injury.  See Traumatic Brain Injury & Concussion, https://www.cdc.gov/traumaticbraininjury/get_the_facts.html (last visited November 18, 2019).