title: Evaluation and management of mild traumatic brain injury: an Eastern Association for the Surgery of Trauma practice management guideline.
abstract: BACKGROUND
  An estimated 1.1 million people sustain a mild traumatic brain injury (MTBI) annually in the United States. The natural history of MTBI remains poorly characterized, and its optimal clinical management is unclear. The Eastern Association for the Surgery of Trauma had previously published a set of practice management guidelines for MTBI in 2001. The purpose of this review was to update these guidelines to reflect the literature published since that time.
  
  
  METHODS
  The PubMed and Cochrane Library databases were searched for articles related to MTBI published between 1998 and 2011. Selected older references were also examined.
  
  
  RESULTS
  A total of 112 articles were reviewed and used to construct a series of recommendations.
  
  
  CONCLUSIONS
  The previous recommendation that brain computed tomographic (CT) should be performed on patients that present acutely with suspected brain trauma remains unchanged. A number of additional recommendations were added. Standardized criteria that may be used to determine which patients receive a brain CT in resource-limited environments are described. Patients with an MTBI and negative brain CT result may be discharged from the emergency department if they have no other injuries or issues requiring admission. Patients taking warfarin who present with an MTBI should have their international normalized ratio (INR) level determined, and those with supratherapeutic INR values should be admitted for observation. Deficits in cognition and memory usually resolve within 1 month but may persist for longer periods in 20% to 40% of cases. Routine use of magnetic resonance imaging, positron emission tomography, nuclear magnetic resonance, or biochemical markers for the clinical management of MTBI is not supported at the present time.
authors.affiliation: Legacy Emanuel Hospital and Health Center, Oregon Health and Science University, Portland, Oregon 97227, USA. Rbarbosa91@yahoo.com
authors.forename: Ronald R
authors.initials: RR
authors.lastname: Barbosa
authors.forename: Randeep
authors.initials: R
authors.lastname: Jawa
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Watters
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Knight
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kerwin
authors.forename: Eleanor S
authors.initials: ES
authors.lastname: Winston
authors.forename: Robert D
authors.initials: RD
authors.lastname: Barraco
authors.forename: Brian
authors.initials: B
authors.lastname: Tucker
authors.forename: James M
authors.initials: JM
authors.lastname: Bardes
authors.forename: Susan E
authors.initials: SE
authors.lastname: Rowell
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging; D001930:Brain Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000592:standards; D006801:Humans; D019934:International Normalized Ratio; D010351:Patient Discharge / Q000592:standards; D014057:Tomography, X-Ray Computed