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Observational Study
. 2018 May 18;1(1):e180210.
doi: 10.1001/jamanetworkopen.2018.0210.

Assessment of Follow-up Care After Emergency Department Presentation for Mild Traumatic Brain Injury and Concussion: Results From the TRACK-TBI Study

Seth A Seabury  1 , Étienne Gaudette  2 , Dana P Goldman  2   3 , Amy J Markowitz  4 , Jordan Brooks  5 , Michael A McCrea  6 , David O Okonkwo  5 , Geoffrey T Manley  7 ; TRACK-TBI Investigators; Opeolu Adeoye  8 , Neeraj Badjatia  9 , Kim Boase  10 , Yelena Bodien  11 , M Ross Bullock  12 , Randall Chesnut  10 , John D Corrigan  13 , Karen Crawford  14 , Ramon Diaz-Arrastia  15 , Sureyya Dikmen  10 , Ann-Christine Duhaime  16 , Richard Ellenbogen  10 , V Ramana Feeser  17 , Adam Ferguson  4 , Brandon Foreman  8 , Raquel Gardner  4 , Joseph Giacino  18 , Luis Gonzalez  19 , Shankar Gopinath  20 , Rao Gullapalli  9 , J Claude Hemphill  4 , Gillian Hotz  12 , Sonia Jain  21 , Frederick Korley  22 , Joel Kramer  4 , Natalie Kreitzer  8 , Harvey Levin  18 , Chris Lindsell  23 , Joan Machamer  10 , Christopher Madden  24 , Alastair Martin  4 , Thomas McAllister  25 , Randall Merchant  17 , Pratik Mukherjee  4 , Lindsay Nelson  26 , Florence Noel  18 , Eva Palacios  4 , Daniel Perl  27 , Ava Puccio  28 , Miri Rabinowitz  28 , Claudia Robertson  20 , Jonathan Rosand  11 , Angelle Sander  20 , Gabriella Satris  4 , David Schnyer  29 , Mark Sherer  19 , Murray Stein  21 , Sabrina Taylor  4 , Nancy Temkin  10 , Arthur Toga  14 , Alex Valadka  17 , Mary Vassar  4 , Paul Vespa  30 , Kevin Wang  31 , John Yue  4 , Esther Yuh  4 , Ross Zafonte  32
Affiliations
Observational Study

Assessment of Follow-up Care After Emergency Department Presentation for Mild Traumatic Brain Injury and Concussion: Results From the TRACK-TBI Study

Seth A Seabury et al. JAMA Netw Open. .

Abstract

Importance: Mild traumatic brain injury (mTBI) affects millions of Americans each year. Lack of consistent clinical practice raises concern that many patients with mTBI may not receive adequate follow-up care.

Objective: To characterize the provision of follow-up care to patients with mTBI during the first 3 months after injury.

Design, setting, and participants: This cohort study used data on patients with mTBI enrolled in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study between February 26, 2014, and August 25, 2016. We examined site-specific variations in follow-up care, the types of clinicians seen by patients receiving follow-up care, and patient and injury characteristics associated with a higher likelihood of receiving follow-up care. The TRACK-TBI study is a prospective, multicenter, longitudinal observational study of patients with TBI presenting to the emergency department of 1 of 11 level I US trauma centers. Study data included patients with head trauma who underwent a computed tomography (CT) scan within 24 hours of injury, had a Glasgow Coma Scale score of 13 to 15, were aged 17 years or older, and completed follow-up care surveys at 2 weeks and 3 months after injury (N = 831).

Main outcomes and measures: Follow-up care was defined as hospitals providing TBI educational material at discharge, hospitals calling patients to follow up, and patients seeing a physician or other medical practitioner within 3 months after the injury. Unfavorable outcomes were assessed with the Rivermead Post Concussion Symptoms Questionnaire.

Results: Of 831 patients (289 [35%] female; 483 [58%] non-Hispanic white; mean [SD] age, 40.3 [16.9] years), less than half self-reported receiving TBI educational material at discharge (353 patients [42%]) or seeing a physician or other health care practitioner within 3 months after injury (367 patients [44%]). Follow-up care varied by study site; adjusting for patient characteristics, the provision of educational material varied from 19% to 72% across sites. Of 236 patients with a positive finding on a CT scan, 92 (39%) had not seen a medical practitioner 3 months after the injury. Adjusting for injury severity and demographics, patient admission to the hospital ward or intensive care unit, patient income, and insurance status were not associated with the probability of seeing a medical practitioner. Among the patients with 3 or more moderate to severe postconcussive symptoms, only 145 of 279 (52%) reported having seen a medical practitioner by 3 months.

Conclusions and relevance: There are gaps in follow-up care for patients with mTBI after hospital discharge, even those with a positive finding on CT or who continue to experience postconcussive symptoms.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Seabury reported grants from the National Institute of Neurological Disorders and Stroke (NINDS) and grants from Research to Prevent Blindness during the conduct of the study and personal fees from Precision Health Economics outside the submitted work. Dr Gaudette reported grants from NINDS during the conduct of the study. Dr Goldman reported grants from the National Institutes of Health (NIH) and from the Leonard D. Schaeffer Center for Health Policy and Economics during the conduct of the study and support from Precision Health Economics outside the submitted work. Ms Markowitz reported personal fees from One Mind and grants from NINDS during the conduct of the study. Dr Manley reported grants from the NIH, Department of Defense (DoD), and One Mind during the conduct of the study as well as grants and nonfinancial support from Abbott and personal fees from the National Football League outside the submitted work. In addition, Dr Manley had a patent to WO2017106645A1 pending. Dr Adeoye reported a patent to US20160278653A1 issued. Ms Boase reported grants from the US federal government both during the conduct of the study and outside the submitted work. Dr Bodien reported grants from NINDS during the conduct of the study. Dr Corrigan reported grants from the University of California, San Francisco, during the conduct of the study. Dr Dikmen reported grants from the US federal government both during the conduct of the study and outside the submitted work. Dr Duhaime reported grants from the NIH during the conduct of the study. Dr Ellenbogen reported grants from the NIH during the conduct of the study. Dr Feeser reported grants from Virginia Commonwealth University during the conduct of the study. Dr Ferguson reported grants from the NIH and NINDS during the conduct of the study and grants from the NIH, NINDS, the Wings for Life Foundation, the Craig H. Neilsen Foundation, and the DoD outside the submitted work. Dr Foreman reported grants from the NIH and NINDS during the conduct of the study. Dr Giacino reported grants from the NIH and NINDS during the conduct of the study. Dr Hemphill reported grants from the NIH and NINDS during the conduct of the study. Dr Levin reported grants from the University of California, San Francisco, during the conduct of the study. Dr Lindsell reported grants from the NIH during the conduct of the study. Ms Machamer reported grants from the US federal government both during the conduct of the study and outside the submitted work. Dr McAllister reported grants from the University of California, San Francisco, during the conduct of the study. Dr Mukherjee reported grants from General Electric Healthcare and nonfinancial support from the General Electric–National Football League Medical Advisory Board during the conduct of the study. Dr Nelson reported grants from the NIH outside the submitted work. Dr Robertson reported grants from the NIH during the conduct of the study. Dr Rosand reported grants from the NIH both during the conduct of the study and outside the submitted work. Dr Sander reported grants from the NIH during the conduct of the study. Dr Stein reported personal fees from Oxeia Biopharmaceuticals outside the submitted work. Dr Temkin reported grants from the US federal government during the conduct of the study and grants from the US federal government and personal fees from Novartis, Celgene, TauRx, Sage, the University of Pittsburgh, and the University of Texas Health Science Center–Houston outside the submitted work. Dr Toga reported grants from the NIH during the conduct of the study. No other disclosures were reported.

Figures

Figure.
Figure.. Adjusted Outcomes for Patients With Mild Traumatic Brain Injury (TBI)
There was wide site-specific variation in patients’ receipt of follow-up care even after adjusting for patient characteristics across sites. The graphs show the adjusted rates of TBI educational material receipt at discharge (A) and having seen a medical practitioner by 3 months (B). The adjusted rate of receiving educational material at discharge varied from 19% to 72%, while the rate of having seen a practitioner at 3 months after injury ranged from 22% to 58%.
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References

    1. Taylor CA, Bell JM, Breiding MJ, Xu L. Traumatic brain injury-related emergency department visits, hospitalizations, and deaths—United States, 2007 and 2013. MMWR Surveill Summ. 2017;66(9):-. - PMC - PubMed
    1. Kay T, Harrington DE, Adams R, et al. Definition of mild traumatic brain injury. J Head Trauma Rehabil. 1993;8(3):86-87.
    1. Coronado VG, Xu L, Basavaraju SV, et al. ; Centers for Disease Control and Prevention (CDC) . Surveillance for traumatic brain injury-related deaths—United States, 1997-2007. MMWR Surveill Summ. 2011;60(5):1-32. - PubMed
    1. McMahon P, Hricik A, Yue JK, et al. ; TRACK-TBI Investigators . Symptomatology and functional outcome in mild traumatic brain injury: results from the prospective TRACK-TBI study. J Neurotrauma. 2014;31(1):26-33. - PMC - PubMed
    1. Yue JK, Vassar MJ, Lingsma HF, et al. ; TRACK-TBI Investigators . Transforming research and clinical knowledge in traumatic brain injury pilot: multicenter implementation of the common data elements for traumatic brain injury. J Neurotrauma. 2013;30(22):1831-1844. - PMC - PubMed

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