Emergency Department Return Visits After Concussion or Mild Traumatic Brain Injury

Acute concussion is a common emergency department (ED) presentation, and patients often return for subsequent related ED visits. The frequency of return ED visits and contributing factors are not well understood. Improved identification of patients at risk for ED return visits may allow for improved counseling, treatment, and follow-up care. Our study objectives were to identify frequency and reasons for return, and patient-specific characteristics associated with ED return visits within 90 days after an index ED visit for acute concussion evaluation.

We conducted a prospective observational cohort study of subjects with concussion evaluated in three academic EDs ≤72 hours post-injury. We assessed concussion symptoms (neurobehavioral symptom inventory [NSI]), cognition (ECog-12), and psychological health measures including anxiety (GAD-7), depression (PHQ-9), and post-traumatic stress (PCL-5). ED return visits within 90 days were determined via manual chart review. We compared measures between subjects with vs without return ED visits using Kruskal-Wallis tests and Fisher exact tests.

Among 139 subjects, there were 28 return ED visits by 21 subjects (15%; mean 1.33 return visits per person). Mean age for all subjects was 33 years, and 58% were female; these were similar in both return and non-return groups. At the return visit, the most common chief complaints were concussion-related symptoms (n=7; 25%), new injury-related complaints (n=6; 21%), intoxication or alcohol withdrawal (n=4; 14%), upper respiratory or viral symptoms (n=4; 14%), and mental health emergencies (n=3; 11%). NSI, ECog-12, GAD-7, PHQ-9, and PCL-5 scores were not significantly different between subjects with vs without return ED visits (all p>0.05).

These novel data identify reasons for return ED visits that can help emergency physicians better counsel and treat patients with acute concussion. The findings highlight importance of follow-up specialty care, as 1 in 4 patients returned because their concussion symptoms were not improved. Also, our data suggest secondary injury prevention, alcohol use mitigation, and mental health referrals may be worthwhile areas of focus.