Mild traumatic brain injury management [Neurosurgery Wiki]

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====== Mild traumatic brain injury management ======

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===== ✅ Initial Assessment =====

[[History]] & [[Mechanism]] of [[Injury]]

Evaluate for [[loss of consciousness]], amnesia, vomiting, seizures, headache, intoxication, anticoagulant use, or neurological symptoms.

[[Neurological Examination]]

Perform a detailed neuro exam and screen for red flags (e.g., focal deficit, worsening headache, confusion).

[[Imaging]]

see [[Computed tomography for mild traumatic brain injury]].


===== 🏥 Emergency Department Disposition =====

Discharge Home if:

GCS 15

Normal CT (or no indication for CT)

No worsening symptoms or comorbid risks

A responsible adult is available at home

Observation/Admission if:

CT shows abnormalities (e.g., small hemorrhages)

The patient is on [[anticoagulant]]s

Significant medical comorbidities

Lack of social support or substance use concerns

===== 📋 Outpatient Management =====

Cognitive and Physical Rest (24–48 hours): Avoid screens, reading, and strenuous activity early on.

Gradual Return to Activities: Stepwise return to school, work, and sports per symptom tolerance.

Symptom Monitoring:

Headache

Dizziness

Sleep disturbances

Difficulty concentrating

Education: Explain expected course, symptom resolution, and red flags that require re-evaluation.

Follow-Up: Typically within 1–2 weeks, especially if symptoms persist.

===== ⚠️ Red Flags for Reassessment =====

Worsening headache or vomiting

Focal neurological deficits

Seizures

Confusion or altered mental status

Balance problems

===== ⏳ Post-Concussion Syndrome (PCS) =====

Persistent symptoms > 4 weeks

Multidisciplinary care may include neurology, neuropsychology, physiotherapy, and vestibular rehab

===== 📚 Key Guidelines & Resources =====

CDC Heads Up Initiative

Brain Trauma Foundation Guidelines

Concussion in Sport Group (CISG) Consensus Statements

National Institute for Health and Care Excellence (NICE) TBI guidelines
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Previous studies have indicated that there is no consensus about the management of mild traumatic brain injury (mTBI) at the emergency department (ED) and during hospital admission
((Foks KA, Cnossen MC, Dippel DW, Maas A, Menon D, van der Naalt J, Steyerberg
EW, Lingsma H, Polinder S. Management of mild traumatic brain injury at the
emergency department and hospital admission in Europe: A survey of 71 neurotrauma
centers participating in the CENTER-TBI study. J Neurotrauma. 2017 Apr 11. doi:
10.1089/neu.2016.4919. [Epub ahead of print] PubMed PMID: 28398105.
)).

Management should begin with removal from risk if a concussion is suspected, and once diagnosis is made, education and reassurance should be provided. Once symptoms have resolved, a graded return-to-play protocol can be implemented with close supervision and observation for return of symptoms. Management should be tailored to the individual, and if symptoms are prolonged, further diagnostic evaluation may be necessary
((Choe MC, Giza CC. Diagnosis and Management of Acute Concussion. Semin Neurol. 
2015 Feb;35(1):29-41. Epub 2015 Feb 25. PubMed PMID: 25714865.)).

===== 🧠 Disparities and Variability in Hospital Management of Mild Traumatic Brain Injury =====

[[Disparities and Variability in Hospital Management of Mild Traumatic Brain Injury]]