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This gap between guideline recommendations and actual practice is not unique to mTBI, with similar difference identified in many clinical disciplines.
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Despite the availability of guidelines, research undertaken within Australia and internationally has shown that care is often inconsistent with these recommendations (see Additional file 1 (Table 1) for further information on the three key recommendations, their relevance to managing this patient group and the evidence underpinning the recommendations). Three key clinical practice recommendations from these guidelines determined as important in an Australian setting are (1) post-traumatic amnesia (PTA) should be prospectively assessed in ED using a validated tool (2) guideline-developed criteria or clinical decision rules should be used to determine the appropriate use and timing of computed tomography (CT) imaging (3) verbal and written patient information consisting of advice, education and reassurance should be provided upon discharge from the ED. Several high quality evidence-based clinical practice guidelines are available to guide the care of patients who present to the ED with mTBI. A small minority (approximately 1%) have underlying intracranial haemorrhage and deteriorate quickly, requiring neurosurgical intervention.
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While the majority of people suffering mTBI will make a full recovery within a few weeks or months, approximately 15–25% will go on to subjectively report post-concussion symptoms such as ongoing headaches, memory and concentration problems, and sleep difficulties. The challenge for ED clinicians is to identify which patients presenting with a head injury require further management and which patients can safely be sent home. People with mild traumatic brain injury (mTBI) are usually managed in the ED and discharged within hours.
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The vast majority (80 to 90% depending on the definition) are classified as ‘mild’ severity. Traumatic brain injury, caused by external forces such as sports, falls or accidents, is a frequent presentation to emergency departments (EDs) worldwide.