Emergency Department Time Course for Mild Traumatic Brain Injury Workup.

Document Type


Publication Date



Emergency Medicine, Trauma & Acute Care Surgery

Journal Title

Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

MeSH Headings

Emergency Service; Brain Concussion Therapy; Patient Discharge; Time Factors; Emergency Care; Human; Glasgow Coma Scale; Scales; Physicians, Emergency United States; United States; Nurses; Retrospective Design; Length of Stay; Patient Admission; Tomography, X-Ray Computed; Head Radiography


Introduction: Mild traumatic brain injury (mTBI) is a common cause for visits to the emergency department (ED). The actual time required for an ED workup of a patient with mTBI in the United States is not well known. National emergency medicine organizations have recommended reducing unnecessary testing, including head computed tomography (CT) for these patients. Methods: To examine this issue, we developed a care map that included each step of evaluation of mTBI (Glasgow Coma Scale Score 13-15) - from initial presentation to the ED to discharge. Time spent at each step was estimated by a panel of United States emergency physicians and nurses. We subsequently validated time estimates using retrospectively collected, real-time data at two EDs. Length of stay (LOS) time differences between admission and discharged patients were calculated for patients being evaluated for mTBI. Results: Evaluation for mTBI was estimated at 401 minutes (6.6 hours) in EDs. Time related to head CT comprised about one-half of the total LOS. Real-time data from two sites corroborated the estimate of median time difference between ED admission and discharge, at 6.3 hours for mTBI. Conclusion: Limiting use of head CT as part of the workup of mTBI to more serious cases may reduce time spent in the ED and potentially improve overall ED throughput.

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