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    3 Comments for this article
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    Importance of Follow-up After TBI
    Frederick Rivara, MD | University of Washington

    This study points out the poor follow-up for many patients with so called "mild" traumatic brain injury (TBI). We know that a sizable proportion of patients will continue to have symptoms for some weeks afterwards, emphasizing the importance of good f/follow-up care that should start with a patient's primary care provider and may need to graduate to specialist care if symptoms continue.

    CONFLICT OF INTEREST: Editor of JAMA Network Open
    42 percent
    Roy Perlis, MD MSc | Massachusetts General Hospital
    To me, the punch line of this paper is in the 3rd paragraph of the results: 42% received educational material at discharge. Lacking education about the diagnosis, it's hard to imagine how patients can be expected to follow up. On the other hand, the wide range of variation across clinics suggests substantial opportunity for improvement.
    CONFLICT OF INTEREST: Associate Editor, JAMA Network Open
    Strongly Agree With Article
    Geraldine Powell, mb bch bao | Retired
    Our son, adopted from Russia was struck in the face in a college rugby match and admitted to an ICU in SC, Glasgow score 8. He was extubated the next morning and spoke mostly unintelligible Russian, which he had not done since age four. He became oriented and started talking English again over the next 12 hours and was moved to a ward.

    The problem with the hospital admission was that once the acute phase was over nobody wanted to problem solve as to what had happened and what kind of care he should have. He didn't
    get any after-care and had headaches for months afterwards and did poorly in college for the next year. Then he seemed to more or less get back to normal.

    There should be a follow-up program offered in a situation like that.
    CONFLICT OF INTEREST: None Reported
    READ MORE
    Original Investigation
    Emergency Medicine
    May 25, 2018

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

    Author Affiliations
    • 1Department of Ophthalmology and Leonard D. Schaeffer Center for Health Policy and Economics, Keck School of Medicine, University of Southern California, Los Angeles
    • 2Leonard D. Schaeffer Center for Health Policy and Economics, School of Pharmacy, University of Southern California, Los Angeles
    • 3Leonard D. Schaeffer Center for Health Policy and Economics, Price School of Public Policy, University of Southern California, Los Angeles
    • 4University of California, San Francisco
    • 5Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
    • 6Department of Neurosurgery, Medical College of Wisconsin, Milwaukee
    • 7Department of Neurological Surgery, University of California, San Francisco
    JAMA Netw Open. 2018;1(1):e180210. doi:10.1001/jamanetworkopen.2018.0210
    Key Points español 中文 (chinese)

    Question  Do patients with mild traumatic brain injury (mTBI) receive adequate levels of follow-up care?

    Findings  In a cohort study using data on 831 patients with mTBI presenting to the emergency department at 1 of 11 level I trauma centers across the United States, 42% of patients reported receiving educational material at discharge and 44% reported seeing a physician or other medical practitioner within 3 months after injury. Among patients with 3 or more moderate to severe postconcussive symptoms, only 52% reported having seen a practitioner within 3 months following the injury.

    Meaning  A large proportion of patients with mTBI do not receive follow-up care after injury even when they experience ongoing postconcussive symptoms.

    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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