August 5, 2013

Guideline Title

Evaluation and management of mild traumatic brain injury: an Eastern Association for the Surgery of Trauma practice management guideline.

Bibliographic Source(s)

Barbosa RR, Jawa R, Watters JM, Knight JC, Kerwin AJ, Winston ES, Barraco RD, Tucker B, Bardes JM, Rowell SE, Eastern Association for the Surgery of Trauma. Evaluation and management of mild traumatic brain injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012 Nov;73(5 Suppl 4):S307-14. [80 references] PubMed External Web Site Policy

Guideline Status

This is the current release of the guideline.
This guideline updates a previous version: EAST Practice Management Guidelines Work Group. Practice management guidelines for the management of mild traumatic brain injury. Winston-Salem (NC): Eastern Association for the Surgery of Trauma (EAST); 2000. 29 p. [76 references]

Evaluation and management of mild t... [J Trauma Acute Care Surg. 2012] - PubMed - NCBI

2012 Nov;73(5 Suppl 4):S307-14. doi: 10.1097/TA.0b013e3182701885.

Evaluation and management of mild traumatic brain injury: an Eastern Association for the Surgery of Trauma practice management guideline.

Barbosa RR, Jawa R, Watters JM, Knight JC, Kerwin AJ, Winston ES, Barraco RD, Tucker B, Bardes JM, Rowell SE; Eastern Association for the Surgery of Trauma.

Source

Legacy Emanuel Hospital and Health Center, Oregon Health and Science University, Portland, Oregon 97227, USA. Rbarbosa91@yahoo.com

Abstract

BACKGROUND:

An estimated 1.1 million people sustain a mild traumatic brain injury (MTBI) annually in the United States. The natural history of MTBI remains poorly characterized, and its optimal clinical management is unclear. The Eastern Association for the Surgery of Trauma had previously published a set of practice management guidelines for MTBI in 2001. The purpose of this review was to update these guidelines to reflect the literature published since that time.

METHODS:

The PubMed and Cochrane Library databases were searched for articles related to MTBI published between 1998 and 2011. Selected older references were also examined.

RESULTS:

A total of 112 articles were reviewed and used to construct a series of recommendations.

CONCLUSION:

The previous recommendation that brain computed tomographic (CT) should be performed on patients that present acutely with suspected brain trauma remains unchanged. A number of additional recommendations were added. Standardized criteria that may be used to determine which patients receive a brain CT in resource-limited environments are described. Patients with an MTBI and negative brain CT result may be discharged from the emergency department if they have no other injuries or issues requiring admission. Patients taking warfarin who present with an MTBI should have their international normalized ratio (INR) level determined, and those with supratherapeutic INR values should be admitted for observation. Deficits in cognition and memory usually resolve within 1 month but may persist for longer periods in 20% to 40% of cases. Routine use of magnetic resonance imaging, positron emission tomography, nuclear magnetic resonance, or biochemical markers for the clinical management of MTBI is not supported at the present time.