Division of Trauma and Acute Care Surgery, Grant Medical Center, OhioHealth, Columbus.
J Trauma Nurs. 2020 Jul/Aug;27(4):225-233. doi: 10.1097/JTN.0000000000000518.
Mild traumatic brain injury (mTBI) remains a prevalent public health concern. Implementation of an mTBI guideline encouraged screening all patients at risk for mTBI, followed by outpatient follow-up in a "concussion clinic." This resulted in an increase in inpatient concussion evaluations, followed by high-volume referral to the concussion clinic. This prompted the routine use of an outpatient mTBI symptom screening tool. The purpose of this quality improvement study was to analyze the characteristics of an mTBI population at outpatient follow-up and describe the clinicians' care recommendations as determined through the use of an mTBI symptom screening tool.
This is a retrospective review of mTBI patients at a Level 1 trauma center. The study includes patients who completed a concussion screening in the outpatient setting over a 6-month period. Patients were included if older than 16 years, sustained blunt trauma, and had a formal neurocognitive evaluation by a certified speech therapist within 48 hr of initial injury.
Of the 247 patients included, 197 (79.8%) were referred to the concussion clinic, 33 (13.4%) had no further outpatient needs, and 17 (6.9%) were referred for outpatient neurocognitive rehabilitation. On follow-up, 97 patients were deemed to have no further postconcussion needs by the trauma nurse practitioner; 57 patients were cleared by the speech therapist. In total, 43 outpatient mTBI follow-up encounters resulted in referral for ongoing therapy.
Routine screening for concussion symptoms and detailed clinical evaluation allows for prompt recognition of further posttraumatic mTBI needs.
轻度创伤性脑损伤（mTBI）仍然是一个普遍存在的公共卫生问题。实施 mTBI 指南鼓励对所有有 mTBI 风险的患者进行筛查，然后在“脑震荡诊所”进行门诊随访。这导致了住院脑震荡评估的增加，随后大量转介到脑震荡诊所。这促使常规使用门诊 mTBI 症状筛查工具。本质量改进研究的目的是分析门诊随访的 mTBI 人群的特征，并描述临床医生通过使用 mTBI 症状筛查工具确定的治疗建议。
这是对 1 级创伤中心的 mTBI 患者进行的回顾性研究。该研究包括在 6 个月的门诊期间完成脑震荡筛查的患者。纳入标准为年龄大于 16 岁，钝器创伤，在初始损伤后 48 小时内由认证言语治疗师进行正式神经认知评估。
在 247 名患者中，197 名（79.8%）被转介到脑震荡诊所，33 名（13.4%）无进一步门诊需求，17 名（6.9%）被转介进行门诊神经认知康复。在随访中，97 名创伤护士从业者认为这些患者没有进一步的脑震荡后需求；57 名由言语治疗师认定为痊愈。总共 43 次门诊 mTBI 随访导致需要进行持续治疗。
常规筛查脑震荡症状和详细的临床评估可以及时发现进一步的创伤后 mTBI 需求。
