Research Reports - Mild traumatic brain injury diagnosis frequently remains unrecorded in subjects with craniofacial fractures

Injury. 2012 Dec;43(12):2100-4

Puljula J, Cygnel H, Mäkinen E, Tuomivaara V, Karttunen V, Karttunen A, Hillbom M.

BACKGROUND: Traumatic brain injuries (TBI) in subjects with craniofacial
fractures are usually diagnosed by emergency room physicians. We investigated how
often TBI remains unrecorded in these subjects, and whether diagnostic accuracy
has improved after the implementation of new TBI guidelines.
METHODS: All subjects with craniofacial fractures admitted to Oulu University
Hospital in 1999 and in 2007 were retrospectively identified. New guidelines for
improving the diagnostic accuracy of TBI were implemented between 2000 and 2006.
Clinical symptoms of TBI were gathered from notes on hospital charts and compared
to the recorded diagnoses at discharge. Logistic regression was used to identify
independent predictors for TBI to remain unrecorded.
RESULTS: Of 194 subjects with craniofacial fracture, 111(57%) had TBI, 40 in 1999
and 71 in 2007. Fifty-one TBIs (46%) remained unrecorded at discharge, 48 being
mild and 3 moderate-to-severe. Subjects with unrecorded TBI were significantly
less frequently referred to follow-up visits. Failures to record the TBI
diagnosis were less frequent (29/71, 41%) in 2007 than in 1999 (22/40, 55%), but
the difference was not statistically significant. The most significant
independent predictor for this failure was the clinical specialty (other than
neurology/neurosurgery) of the examining physician (p<0.001). The subject's
alcohol intoxication did not hamper the diagnosis of TBI.
CONCLUSIONS: TBIs remain frequently unrecorded in subjects with craniofacial
fractures. Recording of mild TBI slightly but insignificantly improved after the
implementation of new guidelines.

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