Mild traumatic brain injury at the emergency department
Mild traumatic brain injury (mTBI) is one of the most common injuries seen at the emergency department (ED). Although most patients recover fully, a considerable proportion develop persistent symptoms such as headache, concentration problems, and fatigue, which impact daily functioning and societal participation. Nevertheless, limited evidence exists regarding early interventions aimed at preventing these symptoms.
This thesis describes the consequences of mTBI across different patient groups. Older adults are more vulnerable: they more often experience complications such as intracranial hemorrhages and deteriorate more frequently during hospital admission, while their symptoms at the ED are less evident. Therefore, we recommend that, for the time being, older patients with mTBI routinely undergo a head CT scan in the ED.
Furthermore, not all patients with mTBI experience the same symptoms or outcomes. Patients presenting with acute neck pain represent a distinct subgroup with more frequent and persistent complaints like dizziness, headache, and neck pain. In addition, patients with a head injury discharged home directly after their ED visit also often report long-term complaints. Risk factors include higher age, acute headache, and physical or mood-related symptoms two weeks after the injury.
Interestingly, despite persistent symptoms, both older adults and children often report good long-term quality of life after (m)TBI, a phenomenon known as the ‘disability paradox’.
The main conclusion of this thesis is that mTBI is not a uniform condition. Different subgroups have specific risk factors and treatment needs. Future research should therefore focus on subgroup-specific, symptom-oriented interventions rather than a one-size-fits-all approach.