RT Journal Article SR Electronic T1 Challenges in the acute identification of mild traumatic brain injuries: results from an emergency department surveillance study JF BMJ Open JO BMJ Open FD British Medical Journal Publishing Group SP e034494 DO 10.1136/bmjopen-2019-034494 VO 10 IS 2 A1 Pozzato, Ilaria A1 Meares, Susanne A1 Kifley, Annette A1 Craig, Ashley A1 Gillett, Mark A1 Vu, Kim Van A1 Liang, Anthony A1 Cameron, Ian A1 Gopinath, Bamini YR 2020 UL http://bmjopen.bmj.com/content/10/2/e034494.abstract AB Objectives To establish the proportion of mild traumatic brain injury (mTBI) diagnosis among people presenting to an emergency department (ED), to determine the accuracy of recorded ED diagnoses. We also aimed to describe challenges in mTBI case identification and its acute hospital management.Design and setting A retrospective chart review of all ED attendances to a major trauma hospital, over a 9-month period (June 2015–February 2016).Participants Adults aged 18–65 years consecutively presenting to an ED.Primary outcome measures Proportion of mTBI diagnosis among ED attendances (ie, confirmed mTBI based on the WHO criteria or indeterminate mTBI based on secondary criteria), and proportion of accurately recorded mTBI diagnosis by ED clinicians (ie, ‘mTBI’, ‘concussion’).Results Of 30 479 ED attendances, 351 (1.15%) confirmed mTBI diagnosis and 180 (0.6%) indeterminate diagnosis were identified. Only 81 (23.1%) individuals with a confirmed mTBI had a ‘mTBI diagnosis’ clearly recorded in the medical notes. Of the allocated discharge diagnosis codes to the two identified cohorts, 89.8% were not indicative of mTBI. Intracranial injuries were found in 31 (8.5%) confirmed cases. Glasgow Coma Scale scores were consistently assessed in the ED but identified only 117 (33.3%) confirmed mTBI cases. Post-traumatic amnesia (PTA) testing was able to confirm acute cognitive impairment in 113 (62.1%) of those who were tested (182, 51.3%).Conclusions mTBI is a common, but an under-recognised cause for ED attendance. Despite challenges, the use of an operational definition such as the WHO diagnostic criteria can improve accuracy in mTBI identification. Acute management may be enhanced by rapid assessment of PTA.