Mild Traumatic Brain Injury: Epidemiology, Management, Outcome

Introduction: Mild traumatic brain injuries represent 80% of the total traumatic brain injuries. Their management is conducted as recommended by EBIC (European Brain Injury Consortium) or WFNS (World Federation of Neurosurgical Societies).The aim of the study is to analyze the management of patients with mild traumatic brain injuries who present at the Emergency Department (ED), of the admitted ones, the paraclinical investigations used and the cerebral lesions which these identify.Material and methods: During a 3 months period, 533 patients with mild traumatic brain injuries presented at the ED. We have followed these patients regarding the demographic data, the causes that led to the mild traumatic brain injuries and the paraclinical investigations used. Regarding the admitted patients, we have taken into consideration risk factors, neurological symptoms, the need to repeat a paraclinical investigation, their management and outcome.Results: Out of the 533 patients who presented at the ED, 248 (65%) were adults and 158 (29.64%) were third age patients. The remaining 27 (5%) were aged between 0-18 years old. Male patients (359; 67%) were more frequently affected than female patients (174; 32.6%). The top three causes were aggressions (57%), car accidents (27%) and same level falls (6.3%). The patients were investigated by skull X-rays (47.8%) and cerebral CT (computed tomography) scans (52.35%).Out of the total number of patients, 198 were admitted; these had the following risk factors: age > 65 years old (31%), alcohol use (18.6%), seizures (7.57%) and the following clinical symptoms: headaches (71%), vomiting (9.6%), dizziness (36.8%), loss of consciousness (31.8%).Out of the admitted patients, only 12 presented cerebral lesions: hemorrhagic brain contusions (n=5), small subdural blood collections (n=3), traumatic subarachnoid hemorrhages (n=2), acute subdural hematoma (n=1) and intraventricular hemorrhage (n=1).The patient with acute subdural hematoma was operated on and had a favorable outcome.The patient with intraventricular hemorrhage, who was 90 years old and presented with coagulopathy, has deceased.All the other patients were discharged after a mean hospitalization period of 3 days.Conclusions: Out of the patients with mild traumatic brain injuries, only a small number present cerebral lesions. For their diagnosis, expensive paraclinical investigations are used in both the ED and the neurosurgical department.Careful monitoring of the evolution of the neurological status and performing a cerebral CT scan only in case of neurological deterioration would save resources that could be targeted for the therapeutic stage