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Majority of patients with mild TBI do not seek follow-up care

More than half of patients with mild traumatic brain injury who presented to the ED did not see a health care practitioner in the 3 months following the TBI, according to findings recently reported in JAMA Network Open.

“While patients with moderate to severe TBI are almost always admitted to a hospital or ICU for close monitoring and intervention, there is considerably less consensus as to best practices for patients with [mild] TBI,” Seth A. Seabury, PhD, of the department of ophthalmology at the Keck School of Medicine at the University of Southern California, and colleagues wrote.

“The lack of consistent clinical practice raises concerns that many patients with [mild] TBI may not receive adequate follow-up care. To date, few studies have investigated follow-up care after [mild] TBI, but what evidence does exist suggests important deficiencies,” they added.

Researchers looked at data from 831 patients (mean age, 40.3 years) with mild TBI who had a CT scan within 24 hours of their TBI, had a Glasgow Coma Scale score of 13 to 15, and took part in follow-up care surveys at 2 weeks and 3 months after injury. Follow-up care was defined as patients seeing a health care provider within 3 months after the TBI, hospitals providing TBI educational material at discharge and hospitals making follow-up calls to patients.

Seabury and colleagues found that only 44% of patients saw a physician or other health care practitioner within 3 months after the TBI; 42% received TBI educational material at discharge; and 27% reported receiving a follow-up call about their brain injury within 2 weeks.

In addition, after adjusting for patient characteristics, provision of educational material varied from 19% to 72% of visits across sites; of the 236 patients with a positive finding on a CT scan, 39% had not seen a medical practitioner within 3 months after the TBI; and among the 279 patients with three or more moderate to severe postconcussive symptoms, only 52% said they had seen a health care practitioner within 3 months of the TBI.

“Our findings reveal the consequences that may result from the absence of systems of follow-up care for patients with [mild] TBI and concussion. They also highlight an apparent lack of appreciation by many clinicians of the substantial symptom and life burdens experienced by a significant proportion of patients with injuries labeled mild,” Seabury and colleagues wrote.

“One contributing factor in the acute and critical care setting is that [mild] TBI comes with extremely low risk of mortality. For that reason, patients with [mild] TBI are often quickly triaged. Increased efforts are warranted to raise ED clinician awareness of the importance of follow-up care to prevent morbidity and disability.”

In a related editorial, Mary Iaccarino, MD, of the department of physical medicine and rehabilitation at Harvard Medical School and Massachusetts General Hospital, wrote that Seabury et al’s findings reveal a “stunning lack of follow-up care” even with the site heterogeneity, lack of multiyear longitudinal follow-up and small sample size that made up the study.

“Despite these limitations, this work is an important notation for next steps in understanding care needs and defining the phenotype of individuals who would most benefit from further education and integrated medical care,” she wrote.

“Future work will be served by approaches that study individuals who are ill and those who are well, defining specific biopsychosocial links to their phenotypic characteristics and furthering the understanding of long-term implications of [mild] TBI. In this manner, we may better define individuals at greatest risk and use meaningful strategies to mitigate injury symptoms and foster recovery,” she added. – by Janel Miller

Disclosure: Iaccarino reports no relevant financial disclosures. Seabury reports receiving 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 all other authors’ relevant financial disclosures.