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Emergency Department Evaluation of Traumatic Brain Injury in the United States, 2009–2010

Korley, Frederick K. MD, PhD; Kelen, Gabor D. MD; Jones, Courtney M. PhD, MPH; Diaz-Arrastia, Ramon MD, PhD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP; Brenner, Lisa PhD, ABPP; Arciniegas, David MD

Journal of Head Trauma Rehabilitation: November/December 2016 - Volume 31 - Issue 6 - p 379–387
doi: 10.1097/HTR.0000000000000187
Original Articles

Objective: To determine the dimensions of traumatic brain injury (TBI) evaluation in US emergency department (EDs) to inform potential application of novel diagnostic tests.

Setting: US EDs.

Participants: National Hospital Ambulatory Medical Care Survey of ED visits in 2009 and 2010 where TBI was evaluated (1) and diagnosed either clinically or (2) with head computed tomographic (CT) scans.

Design: Retrospective cross-sectional.

Results: TBI was evaluated during 4.8 (95% confidence interval [CI], 4.2-5.4) million visits per year; and head CT scan was performed in 82% of TBI evaluations (3.9 [95% CI, 3.4-4.4] million visits per year). TBI was diagnosed in 52% of evaluations (2.5 [95% CI, 2.1-2.8] million visits per year). Among those who received head CT scans, 9% had CT evidence of traumatic abnormalities. Among patients evaluated for TBI who had a Glasgow Coma Scale score recorded, 94.5% were classified as having mild TBI, 2.1% as moderate TBI, and 3.5% as severe TBI. Among patients with International Classification of Diseases, Ninth Revision, Clinical Modification, codes permitting the calculation of head Abbreviated Injury Scale scores 9.0%, 85.0%, 2.5%, 3.2%, 0.3%, and 0% had head Abbreviated Injury Scale scores of 1, 2, 3, 4, 5, and 6, respectively. Of patients evaluated for TBI, 31% had other head/face/neck injuries, 10% had spine and back injuries, 7% had torso injuries, and 14% had extremity injuries.

Conclusion: The ED is the main gateway to medical care for millions of patients evaluated for TBI each year. Novel diagnostic tests are needed to improve ED diagnosis and management of TBI.

Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland (Drs Korley and Kelen); The School of Medicine and Dentistry, University of Rochester, Rochester, New York (Dr Jones); and Center for Neuroscience and Regenerative Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Dr Diaz-Arrastia).

Corresponding Author: Frederick K. Korley, MD, PhD, Department of Emergency Medicine, Johns Hopkins University School of Medicine, Davis Bldg, Ste 3220, 5801 Smith Ave, Baltimore, MD 21209 (

The authors declare no conflicts of interest.

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