title: Understanding Why Patients Return to the Emergency Department after Mild Traumatic Brain Injury within 72 Hours.
abstract: BACKGROUND
  Although there are approximately 1.1 million case presentations of mild traumatic brain injury (mTBI) in the emergency department (ED) each year, little data is available to clinicians to identify patients who are at risk for poor outcomes, including 72-hour ED return after discharge. An understanding of patients at risk for ED return visits during the hyperacute phase following head injury would allow ED providers to develop clinical interventions that reduce its occurrence and improve outcomes.
  
  
  METHODS
  This institutional review board-approved consecutive cohort study collected injury and outcome variables on adults with the purpose of identifying positive predictors for 72-hour ED return visits in mTBI patients.
  
  
  RESULTS
  Of 2,787 mTBI patients, 145 (5%) returned unexpectedly to the ED within 72 hours of hospital discharge. Positive predictors for ED return visits included being male (p=0.0298), being black (p=0.0456), having a lower prehospital Glasgow Coma Score (p=0.0335), suffering the injury due to a motor vehicle collision (p=0.0065), or having a bleed on head computed tomography (CT) (p=0.0334). ED return visits were not significantly associated with age, fracture on head CT, or symptomology following head trauma. Patients with return visits most commonly reported post-concussion syndrome (43.1%), pain (18.7%), and recall for further clinical evaluation (14.6%) as the reason for return. Of the 124 patients who returned to the ED within 72 hours, one out of five were admitted to the hospital for further care, with five requiring intensive care unit stays and four undergoing neurosurgery.
  
  
  CONCLUSIONS
  Approximately 5% of adult patients who present to the ED for mTBI will return within 72 hours of discharge for further care. Clinicians should identify at-risk individuals during their initial visits and attempt to provide anticipatory guidance when possible.
authors.affiliation: North Florida South Georgia Veterans Affairs Medical Center, Lake City, Florida.
authors.forename: Latha
authors.initials: L
authors.lastname: Ganti
authors.affiliation: University of Florida College of Medicine, Gainesville, Florida.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Conroy
authors.affiliation: Saint Louis University, Department of Neurology, Saint Louis, Missouri.
authors.forename: Aakash
authors.initials: A
authors.lastname: Bodhit
authors.affiliation: New York University, College of Arts & Sciences, New York, New York.
authors.forename: Yasamin
authors.initials: Y
authors.lastname: Daneshvar
authors.affiliation: University of Florida, Department of Emergency Medicine, Gainesville, Florida.
authors.forename: Pratik Shashikant
authors.initials: PS
authors.lastname: Patel
authors.affiliation: University of California at San Diego, College of Arts & Sciences, San Diego, California.
authors.forename: Sarah
authors.initials: S
authors.lastname: Ayala
authors.affiliation: Florida State University, College of Medicine, Tallahassee, Florida.
authors.forename: Sudeep
authors.initials: S
authors.lastname: Kuchibhotla
authors.affiliation: George Washington University, Washington District of Columbia.
authors.forename: Kelsey
authors.initials: K
authors.lastname: Hatchitt
authors.affiliation: Tulane University, New Orleans, Louisiana.
authors.forename: Christa
authors.initials: C
authors.lastname: Pulvino
authors.affiliation: University of Florida, Department of Radiology, Gainesville, Florida.
authors.forename: Keith R
authors.initials: KR
authors.lastname: Peters
authors.affiliation: University of Florida, Department of Surgery, Gainesville, Florida.
authors.forename: Lawrence L
authors.initials: LL
authors.lastname: Lottenberg
mesh_terms: D001924:Brain Concussion / Q000150:complications / Q000453:epidemiology* / Q000209:etiology; D001930:Brain Injuries / Q000150:complications*; D004636:Emergency Service, Hospital; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D038223:Post-Concussion Syndrome / Q000453:epidemiology*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed