Current recommendations for the management of mild TBI include accurate diagnosis, assessment of post-traumatic amnesia (PTA), information provision and consideration of follow-up.1,5,10–12 In view of these factors, this study aims to assess current practice at Christchurch Hospital and consider avenues for improvement. The harm caused by mild TBI is recognised in the TBI strategy and action plan of the Accident Corporation Commission (ACC),1 an organisation providing compulsory insurance cover for personal injury for all New Zealand citizens. In a 2014 population-based study of TBI patients, an incidence-based cost of illness model estimated the total lifetime cost per person with mild TBI in New Zealand as NZD $6,878 (95% CI: 5573–8251).7 While on a case-by-case basis this is lower than for moderate/severe TBI, the high prevalence of mild TBI meant the total cost of mild TBI treatment was three times higher than for the moderate/severe group.7 This is in keeping with data showing between 20–47.9% of individuals suffering from mild TBI will have ongoing symptoms at one year follow-ups.8,9 TBIs also incur significant costs for the health system. These concerns are corroborated with the high proportion of missed diagnoses in the emergency department (ED) and the low rate of follow-up seen in two recent large cohort studies.4–6 An estimated 36,000 traumatic brain injuries (TBIs) occur in New Zealand each year, with a large proportion of these being mild.1 Indeed, the incidence of mild TBI in New Zealand has been reported as high as 749 per 100,000 people per year.2 Rates of TBI in Australia have been reported as high as 107 per 100,000 people per year.3 Morbidity can include ongoing headaches, dizziness, nausea, as well as cognitive, mood and sleep disturbance, all of which can significantly impact on quality of life.4,5 Furthermore, the incidence of mild TBI is also likely underestimated due to underdiagnosis, which precludes follow-up and may result in worse long-term outcomes.

Mild traumatic brain injury (mild TBI) represents a significant burden of morbidity and health expense.

Melissa tranter