More than half of concussion patients seen at top-level trauma centers appear to fall off the radar shortly after diagnosis, allowing for the potential development of long-term problems, according to a new study by researchers at the University of California, San Francisco (UCSF) and the University of Southern California.
Growing evidence, including two UCSF studies published earlier this month, shows that traumatic brain injuries are tied to an increased risk for neurodegenerative and psychiatric disorders, such as dementia and Parkinson’s disease.
Among 831 patients treated in hospital emergency departments for mild traumatic brain injury (TBI), only 44 percent saw a physician or other medical provider within three months, according to the findings published in the journal JAMA Network Open.
“The focus of concussion has been directed at a very narrow segment of the population — football players and professional athletes,” said the study’s co-author Geoffrey Manley, M.D., Ph.D., a professor of neurosurgery in the UCSF Department of Neurological Surgery and member of the UCSF Weill Institute for Neurosciences.
“Everyone who falls off their bike or slips off their skateboard or down the steps needs to be aware of the potential risks of concussion.”
Manley called the gap in care a “public health crisis.” He is the principal investigator of TRACK-TBI, which has collected and analyzed clinical data on close to 3,000 traumatic brain injury patients from 18 top-level trauma centers nationwide.
“If physicians did not follow up on patients in the emergency department with diabetes and heart disease, there would be accusations of malpractice,” he said. “For too many patients, concussion is being treated as a minor injury.”
Among the patients who did see a health care provider within three months, only 15 percent visited a clinic that specialized in concussion or traumatic brain injuries. Approximately half saw a general practitioner, who may or may not have training in managing this condition.
Perhaps most disturbing was the finding that even among patients with more serious signs and symptoms, many had no further care after hospital discharge. For example, the CT scans of 236 patients indicated a lesion, but 40 percent of these did not see a health care provider within three months after discharge.
In addition, 279 patients showed three or more moderate-to-severe post-concussive symptoms, but 41 percent of these did not see a physician or health provider within three months after discharge. In fact, around half of the patients were discharged without a handout explaining symptoms and red flags requiring follow-up.
“The lack of follow-up is concerning because these patients can receive adverse and debilitating symptoms for a very long time,” said lead author Seth Seabury, Ph.D., director of the Keck-Schaeffer Initiative for Population Health Policy at the University of Southern California. “Even patients who reported experiencing significant post-concussive symptoms often failed to see a provider. This reflects a lack of awareness among patients and providers that their symptoms may be connected to brain injury.”
Concussion and other more serious forms of traumatic brain injury affect between 3.2 million and 5.3 million Americans, according to the Centers for Disease Control and Prevention.
Undiagnosed and untreated traumatic brain injuries are extremely common in the homeless and incarcerated populations, said Manley, chief of neurosurgery at the Zuckerberg San Francisco General Hospital and Trauma Center.
“We have all these people untreated and no real system of care,” he said. “Even in the best trauma centers in the country, patients with concussion are not getting the follow-up care they desperately need.”
Among the study subjects, who had been recruited from 11 trauma centers throughout the country, the average age was 40; 58 percent were white and 65 percent were male. Around one-third suffered moderate-to-severe post-concussive symptoms. In total, 59 percent of the concussions resulted from a road traffic incident; versus 24 percent from falls and 6 percent from assaults.