Doctors fail to flag concussion patients for critical follow-up

May 25, 2018, University of California, San Francisco
Credit: CC0 Public Domain

As evidence builds of more long-term effects linked to concussion, a nationwide study led by scientists at UCSF and the University of Southern California has found that more than half of the patients seen at top-level trauma centers may fall off the radar shortly after diagnosis, placing in jeopardy treatments for these long-term effects.

Among 831 treated in hospital emergency departments for concussion, or mild (TBI), only 44 percent saw a physician or other medical provider within three months, the scientists report. The study appears in JAMA Network Open on May 25, 2018.

Concussion and other more serious forms of traumatic brain affect between 3.2 million and 5.3 million Americans, according to the Centers for Disease Control and Prevention. An expanding volume of research has found that traumatic brain injuries are associated with an elevated risk for neurodegenerative and psychiatric disorders. Research includes two UCSF studies published earlier this month that found a link between concussion and Parkinson's disease, and concussion and dementia.

"The focus of concussion has been directed at a very narrow segment of the population—football players and professional athletes," said the study's co-author Geoffrey Manley, MD, Ph.D., a professor of neurosurgery in the UCSF Department of Neurological Surgery and member of the UCSF Weill Institute for Neurosciences. "Everyone who falls off their bike or slips off their skateboard or down the steps needs to be aware of the potential risks of concussion."

Concussion Treated as Minor Injury for 'Too Many Patients'

"This is a public health crisis that is being overlooked," said Manley, who is the principal investigator of TRACK-TBI, which has collected and analyzed clinical data on close to 3,000 traumatic brain injury patients from 18 top-level trauma centers nationwide, and was used in this study. "If physicians did not follow up on patients in the emergency department with diabetes and heart disease, there would be accusations of malpractice. For too many patients, concussion is being treated as a minor injury."

The researchers found that of those patients who saw a provider within three months, 15 percent visited a clinic that specialized in concussion or traumatic brain injuries, while approximately half saw a general practitioner, who may or may not have training in managing this condition. More worrisome was the finding that even among those concussion patients with more serious signs and symptoms, many had no further care after hospital discharge. Of the 236 patients whose CT scans indicated a lesion, and 279 patients with three or more moderate-to-severe post-concussive symptoms, 40 and 41 percent, respectively, did not see a physician or health provider within three months after discharge.

Additionally, approximately half of the patients were discharged without a handout explaining symptoms and red flags requiring follow-up.

"The lack of follow-up is concerning because these patients can receive adverse and debilitating symptoms for a very long time," said lead author Seth Seabury, Ph.D., director of the Keck-Schaeffer Initiative for Population Health Policy at the University of Southern California. "Even patients who reported experiencing significant post-concussive symptoms often failed to see a provider. This reflects a lack of awareness among patients and providers that their symptoms may be connected to brain injury."

TBIs Endemic Among Homeless, Prison Populations

Undiagnosed and untreated traumatic injuries are endemic in the homeless and incarcerated populations, said Manley, who is also chief of neurosurgery at the Zuckerberg San Francisco General Hospital and Trauma Center.

"We have all these people untreated and no real system of care," he said. "Even in the best trauma centers in the country, patients with are not getting the follow-up care they desperately need."

Among the patients in the study, who had been recruited from 11 trauma centers throughout the country, 58 percent were white, 65 percent were male and their average age was 40. Approximately one-third suffered moderate-to-severe post-concussive symptoms. In total, 59 percent of the concussions resulted from a road traffic incident; versus 24 percent from falls and 6 percent from assaults.

Explore further: Dementia risk doubles following concussion, study shows

More information: Assessment of follow-up care after emergency department presentation for mild traumatic brain injury and concussion: Results from the TRACK-TBI study, JAMA Network Open, jamanetwork.com/journals/jaman … etworkopen.2018.0201

Related Stories

Dementia risk doubles following concussion, study shows

May 7, 2018
Dementia should join the expanding list of possible complications following concussion, even if the patient did not lose consciousness, say researchers from UCSF Weill Institute for Neurosciences and the San Francisco Veterans ...

Just one concussion could raise Parkinson's risk

April 18, 2018
If you've ever had a mild concussion, your risk of developing Parkinson's disease goes up by 56 percent, a new study of more than 300,000 U.S. veterans suggests.

Zebrafish brain repair following concussion

January 2, 2018
A simple and inexpensive zebrafish model of concussion, reported in eNeuro, reveals the genetic pathways underlying the animal's remarkable ability to regenerate injured brain tissue. Understanding the mechanisms of regeneration ...

Single concussion may cause lasting brain damage

March 12, 2013
A single concussion may cause lasting structural damage to the brain, according to a new study published online in the journal Radiology.

Know the signs of concussion

August 2, 2017
(HealthDay)—Concussions have been in the news a lot because of health problems experienced by football players, but you don't have to be a professional athlete to suffer this injury.

Concussion rates rising significantly in adolescents

August 18, 2016
The number of Americans diagnosed with concussions is growing, most significantly in adolescents, according to researchers at UC San Francisco. They recommend that adolescents be prioritized for ongoing work in concussion ...

Recommended for you

Study of protein 'trafficker' provides insight into autism and other brain disorders

September 22, 2018
In the brain, as in business, connections are everything. To maintain cellular associates, the outer surface of a neuron, its membrane, must express particular proteins—proverbial hands that reach out and greet nearby cells. ...

Breast milk may be best for premature babies' brain development

September 21, 2018
Babies born before their due date show better brain development when fed breast milk rather than formula, a study has found.

Early warning sign of psychosis detected

September 21, 2018
Brains of people at risk of psychosis exhibit a pattern that can help predict whether they will go on to develop full-fledged schizophrenia, a new Yale-led study shows. The findings could help doctors begin early intervention ...

White matter repair and traumatic brain injury

September 20, 2018
Traumatic brain injury (TBI) is a leading cause of death and disability in the U.S., contributing to about 30 percent of all injury deaths, according to the CDC. TBI causes damage to both white and gray matter in the brain, ...

Gut branches of vagus nerve essential components of brain's reward and motivation system

September 20, 2018
A novel gut-to-brain neural circuit establishes the vagus nerve as an essential component of the brain system that regulates reward and motivation, according to research conducted at the Icahn School of Medicine at Mount ...

Genomic dark matter activity connects Parkinson's and psychiatric diseases

September 20, 2018
Dopamine neurons are located in the midbrain, but their tendril-like axons can branch far into the higher cortical areas, influencing how we move and how we feel. New genetic evidence has revealed that these specialized cells ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.