Physicians and Other Consultants: Part I

The emergency-department physician

In the emergency department, the primary goal of the initial neurological evaluation is to rule out the presence of conditions requiring neurosurgical attention (hematomas, depressed skull fractures, elevated intracranial pressure, etc.).

A detailed medical history including prior injuries, seizure disorder, psychiatric or psychological treatment, learning disability, and/or substance abuse should be included along with a Glasgow Coma Scale assessment.

A complete physical examination should be given.

Screening for possible recent drug/alcohol intoxication must be completed. Intoxication can influence the Glasgow Coma Scale and other behavior.

An early CT scan of the brain should be performed to rule out possible bleeding when loss of consciousness or a period of post-trauma amnesia is reported. However, it must be recognized that no neurodiagnostic test alone will diagnose cerebral concussion.

If initially evaluated in an emergency department and released without hospital admission, a referral is typically made to a personal physician.

The personal physician

It is essential that the physician closely monitor the injured person's MTBI symptoms and provides supportive education over the initial 30 days after the injury. If symptoms subside within a 30- to 60-day period, the person can be reassured and advised about precautionary measures to prevent future head injury. However, if symptoms do not completely subside or become worse, immediate, appropriate referrals should be made to a neurologist and, subsequently, to a neuropsychologist for evaluation. Although the physician often tries to manage a case, the comprehensive approach to assessment and treatment requires an MTBI-experienced case manager to be involved.

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