Mild Brain Injury Frequently Missed in the ED

TOPLINEMild traumatic brain injury (mTBI) was diagnosed or suspected in only 21% of emergency department (ED) patients treated for closed head injury, despite 41% of patients meeting consensus diagnostic criteria for the condition, with middle-aged adults experiencing the highest rate of missed diagnoses, a retrospective study found.METHODOLOGYResearchers conducted a retrospective cohort study involving adults with closed head injury or mTBI (n = 314) treated and discharged from 18 EDs within one integrated health system in the US over 3 months in 2023 (42% aged 65 years or older; 76% from urban areas; 62% women; 81% White individuals).Investigators assessed whether clinician-documented mTBI diagnoses at ED discharge aligned with the 2023 American Congress of Rehabilitation Medicine (ACRM) consensus diagnostic criteria, which define mTBI by the presence of one or more clinical signs (loss of consciousness, posttraumatic amnesia, or alteration of consciousness) or two or more symptoms after a plausible mechanism of injury.Analysis included documentation of mTBI symptoms, ED diagnosis patterns, outpatient follow-up within 40 days, and diagnosis at follow-up, with findings analyzed according to age group (18-39 years, 40-64 years, and 65 years or older) and rurality (urban, suburban, and rural).Outcomes included the sensitivity and specificity of ED mTBI diagnoses, assessed against the ACRM criteria, as well as missed diagnoses and follow-up care patterns across demographic groups.TAKEAWAYDefinite or suspected mTBI was identified by ED physicians in 21% of patients, whereas definite or suspected mTBI according to ACRM definitional criteria was identified in 41% of patients (P < .001), representing a false-negative rate of 55%.ED mTBI diagnosis showed high specificity (95%) but low sensitivity (45%) when assessed against the ACRM criteria, with an overall diagnostic accuracy of 74.5%.Middle-aged adults (40-64 years) had the highest rate of missed mTBI diagnosis, which was 34% and significantly higher than that in other age groups combined (P = .005).Young adults (18-39 years) were most frequently diagnosed with definitive or suspected mTBI in the ED, followed by middle-aged adults and older adults (P < .001).IN PRACTICE"This retrospective study showed a significant amount of false negatives/missed mTBI based on our definition on retrospective review, as well as only a minority of patients with documented post-ED follow-up," the authors wrote."Increased awareness among ED physicians of mTBI diagnostic criteria and practices could help better facilitate patient care and continuity with outpatient services beneficial in recovering from head injury," they added.SOURCEThe study was led by Sarah Suchko, University of Pittsburgh School of Medicine, Pittsburgh. It was published online on August 11, 2026, in The American Journal of Emergency Medicine.LIMITATIONSThe study was limited by small sample sizes in some subgroups, particularly patients from rural areas. Follow-up data were restricted to information documented in the health system's electronic medical record. The study was also limited by its retrospective design and potential underestimation of mTBI incidence among patients with sparse ED documentation.DISCLOSURESThe study was funded by the National Institutes of Health through the Clinical and Translational Sciences Institute at the University of Pittsburgh. The authors reported having no competing interests.This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.