Schwartz/Reisman Emergency Medicine Institute

Head Injury Study

Mild Traumatic Brain Injury Study: The Influence of Cognitive Rest and Graduated Return to Usual Activities Emergency Department Discharge Instructions on Symptoms of Mild Traumatic Brain Injury.

It is estimated 15-50% of patients with a mild traumatic brain injury (MTBI) diagnosed in the emergency department (ED) will develop post-concussive syndrome (PCS). Although expert consensus recommends cognitive rest and graduated return to usual activities, these interventions are not based on prospective clinical evidence.

SREMI scientists have recently completed a pragmatic, randomized trial of adult (18-64 years) patients presenting to the ED with chief complaint ‘head injury’ occurring within 24 hours of ED visit. The objective was to determine if patients randomized to graduated return to usual activity discharge instructions had a decrease in their Post-Concussion Symptom Score (PCSS) 2 weeks after MTBI compared to patients who received usual care MTBI discharge instructions.

118 patients were enrolled in the study (58 in the control group and 60 in the intervention). There was no difference with respect to change in PCSS at 2 weeks (10.5 vs 12.8; Δ 2.3, 95% CI: 7.0, 11.7) and 4 weeks post-ED discharge (21.1 vs 18.3; Δ 2.8, 95% CI: 6.9, 12.7) for the intervention and control groups, respectively. The number of follow-up physician visits and time off work/school was similar when the groups were compared.

Based on preliminary data, graduated return to usual activity discharge instructions do not impact rate of resolution of MTBI symptoms 2 weeks after ED discharge. Given that patients continue to experience low to moderate symptoms 2 weeks after MTBI, more investigation is needed to determine how best to counsel and treat patients with post-concussive symptoms.