Traumatic brain injury (TBI) is a condition that occurs due to exaggerated mechanical forces applied to the head resulting in a disruption to normal brain function [1]. These disruptions can manifest in varying degrees of patient impact from subtle cognitive changes, to largely altered mental states [2]. TBI impacts patient recovery from traumatic events and can cause long term mental effects such as dementia, stroke, epilepsy, post-traumatic stress disorder and depression [1]. TBI can also have effects beyond the patient by increasing burden on patients’ families and the broader healthcare system. Epidemiological studies have shown an increasing incidence of TBI over the last 3 decades, with an annual global cost burden of $400 billion dollars [3].

The diagnostic criteria for TBI includes patient history of the traumatic incident and the Glasgow Coma Scale (GCS), which is a 15-point scale testing the severity of the TBI [4]. TBI can be rated on a scale from mild to severe based on time of lost consciousness immediately following the traumatic event, confusion, post-traumatic amnesia, and any other pertinent cognitive impairments specifically impacting responses in the eye, motor, and verbal domains [4], [5], [6]. Mild TBI (mTBI), which includes concussion, is the most common form of TBI and can be hard to distinguish using the GCS [6,7]. Identification of mTBI can also be missed due to lack of screening during the critical time of a trauma [6,8]. The inability to screen may be due in part to patients with mTBI not seeking medical attention until days to weeks later, and often not at all [7]. Additionally, the diagnosis can be difficult to make as the signs and symptoms of mTBI can be subtle following a traumatic injury and may not show up on subsequent CT imaging [9], [10], [11].

There is no standardized treatment protocol for TBI since symptoms vary due to the diversity of clinical presentations and patient needs [5]. Treatment options often include pharmaceutical therapeutics, patient education, cognitive therapy, speech therapy, and physical therapy [5,12,13]. Severity of the TBI influences the treatment plan, with severe TBI requiring more substantial interventions early in the course of the injury presentation [1,14]. Previously, mTBI instances were thought to require only passive surveillance, but newer studies have shown the efficacy of earlier treatment plans including, but not limited to, increased neuropsychological assessments, and patient education with clear guidance on return to activity [1,15]. A multidisciplinary team of patient care specialists can also be involved in TBI rehabilitation including neurologists, occupational therapists, physical therapists, speech therapists, and physiatrists [12,13]. Early diagnosis of mTBI and appropriate treatment plans can significantly improve patient recovery [10,12]. Recommendations for care of a patient may differ slightly between those with TBI versus those with mTBI, but the general steps include diagnosis, multidisciplinary treatment plan, patient education, and follow up plans for treatment to ensure optimal patient recovery (Table 1) [13,16].

The goal of this study is to 1) assess the incidence of TBI in the orthopaedic trauma population, 2) analyse patient characteristics associated with TBI during inpatient stay, and 3) identify the impact of TBI diagnosis on intervention and patient care.