Management of mild traumatic brain injuries in emergency departments in Sweden: evidence of a change in clinical practice.

Abstract

OBJECTIVE: A study published in 2000 on the acute clinical management of mild traumatic brain injuries in Sweden showed that these patients were routinely admitted to hospital for observation. This study aims to compare current clinical management of mild traumatic brain injury with clinical practice a decade ago. DESIGN: Questionnaire to senior residents in all emergency departments in Sweden and data from registers covering all in-hospital care in Sweden. RESULTS: The response rate to the questionnaire was 100%. In Sweden, 71 emergency departments treat patients with mild traumatic brain injuries. An estimated mean of 58% of patients with mild traumatic brain injuries receive computerized tomography scanning, which represents a 3-fold increase compared with 2000. In 2010, Swedish hospitals admitted 8821 patients for mild traumatic brain injuries (94 per 100,000 inhabitants). This figure is approximately half that of 1996, when 16,877 patients were treated as inpatients for mild traumatic brain injuries (191 per 100,000 inhabitants). However, admission rates continue to vary widely among departments. The mean hospital stay 2010 was 1.21 days, compared with 1.6 days in 1996. CONCLUSION: This study provides evidence of a change in clinical practice in the acute management of mild traumatic brain injuries in Sweden. Acute management is increasingly based on computed tomography, and in-hospital observation is used less frequently as a strategy for these patients.