• Edward A Michelson, J Stephen Huff, Mae Loparo, Rosanne S Naunheim, Andrew Perron, Martha Rahm, David W Smith, Joseph A Stone, and Ariel Berger.
• Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, Department of Emergency Medicine, El Paso, Texas.
• West J Emerg Med. 2018 Jul 1; 19 (4): 635-640.

IntroductionMild traumatic brain injury (mTBI) is a common cause for visits to the emergency department (ED). The actual time required for an ED workup of a patient with mTBI in the United States is not well known. National emergency medicine organizations have recommended reducing unnecessary testing, including head computed tomography (CT) for these patients.10.MethodsTo examine this issue, we developed a care map that included each step of evaluation of mTBI (Glasgow Coma Scale Score 13-15) - from initial presentation to the ED to discharge. Time spent at each step was estimated by a panel of United States emergency physicians and nurses. We subsequently validated time estimates using retrospectively collected, real-time data at two EDs. Length of stay (LOS) time differences between admission and discharged patients were calculated for patients being evaluated for mTBI.ResultsEvaluation for mTBI was estimated at 401 minutes (6.6 hours) in EDs. Time related to head CT comprised about one-half of the total LOS. Real-time data from two sites corroborated the estimate of median time difference between ED admission and discharge, at 6.3 hours for mTBI.ConclusionLimiting use of head CT as part of the workup of mTBI to more serious cases may reduce time spent in the ED and potentially improve overall ED throughput.

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