{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T17:46:59Z","timestamp":1785865619362,"version":"3.56.0"},"reference-count":13,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Traumatic brain injuries, or TBIs, represent a common military health care system challenge due to the high frequency seen throughout the 21st century battlefield, workplace injuries, and other traumatic accidents. There is clear-cut guidance for the identification and treatment of moderate-to-severe TBIs, but most presentations are classified as mild. This quality improvement study evaluated whether incorporating a quantitative electroencephalogram (qEEG) device could improve triage accuracy, refine the referral pathway, and align mild TBI care with Defense Health Agency (DHA) recommendations within a military emergency department.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Investigators conducted a prospective cohort study with a secondary retrospective quality improvement analysis at a U.S. military treatment facility (MTF) emergency department (ED). One hundred patients with recent closed head injuries were evaluated using qEEG and calculated Brain Function Index (BFI) scores. Patients whose score correlated with a clinically significant brain injury (\u226450) were referred to a TBI clinic. Patients with a score &amp;gt;50 were advised to follow up with their primary care provider (PCP). The primary objective was to evaluate the use of BFI scores to triage patients presenting with mild TBI to routine or TBI clinic follow-up, using descriptive statistics to compare their characteristics and assess factors associated with appropriate referral to the TBI clinic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Patients in the TBI clinic group (n\u2009=\u200962) averaged a follow-up within 5 days and a return to duty within 20 days. The PCP group (n\u2009=\u200938) had a follow-up averaging 8 days and a return-to-duty of 9 days. In the PCP group, 10% were subsequently referred to a TBI specialist. Collectively, a total of 43 non-contrast head computed tomography scans were ordered: 48% in the TBI clinic group and 46% in the PCP group, all without significant abnormal findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Patients referred to TBI clinics had faster follow-up and less variability than the primary care group, suggesting a more efficient process for TBI-specific referrals that closely aligns with DHA recommendations. Ten percent of patients referred to primary care required referrals to TBI clinics, indicating appropriate identification and a low rate of missed referrals from the ED. Patients referred to TBI clinics had longer recovery times, reflecting that these clinics identify and address more complex cases and provide essential care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usag371","type":"journal-article","created":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T11:41:12Z","timestamp":1784979672000},"source":"Crossref","is-referenced-by-count":0,"title":["Evaluating Point-of-Care Electroencephalogram for Mild Traumatic Brain Injury Triage and Referral Pathways Within the Emergency Department: A Mixed-Design Cohort Quality Improvement Study"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-0847-741X","authenticated-orcid":false,"given":"Joshua D","family":"Lesko","sequence":"first","affiliation":[{"name":"Emergency Medicine Department, Navy Medicine Readiness and Training Command , Portsmouth, VA 23708,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A","family":"Bogdan","sequence":"additional","affiliation":[{"name":"Emergency Medicine Department, Navy Medicine Readiness and Training Command , Portsmouth, VA 23708,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary","family":"Saxman","sequence":"additional","affiliation":[{"name":"Emergency Medicine Department, Navy Medicine Readiness and Training Command , Portsmouth, VA 23708,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Boschee","sequence":"additional","affiliation":[{"name":"Emergency Medicine Department, Navy Medicine Readiness and Training Command , Portsmouth, VA 23708,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric J","family":"Koch","sequence":"additional","affiliation":[{"name":"Emergency Medicine Department, Navy Medicine Readiness and Training Command , Portsmouth, VA 23708,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"2026080412431481700_usag371-B1","author":"Defense Health Agency","year":"2024"},{"key":"2026080412431481700_usag371-B2","doi-asserted-by":"publisher","first-page":"e2326296","DOI":"10.1001\/jamanetworkopen.2023.26296","article-title":"Associations of military-related traumatic brain injury with new-onset mental health conditions and suicide risk","volume":"6","author":"Brenner","year":"2023","journal-title":"JAMA Netw Open"},{"key":"2026080412431481700_usag371-B3","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1097\/TA.0000000000003497","article-title":"Epidemiology, patterns of care, and outcomes of traumatic brain injury in deployed military settings: implications for future military operations","volume":"93","author":"Dengler","year":"2022","journal-title":"J Trauma Acute Care Surg"},{"key":"2026080412431481700_usag371-B4","year":"2022"},{"key":"2026080412431481700_usag371-B5","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1097\/HTR.0000000000000187","article-title":"Emergency department evaluation of traumatic brain injury in the United States, 2009-2010","volume":"31","author":"Korley","year":"2016","journal-title":"J Head Trauma Rehabil"},{"key":"2026080412431481700_usag371-B6","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1089\/neu.2017.5004","article-title":"A brain electrical activity (EEG) based biomarker of functional impairment in traumatic head injury: a multisite validation trial","volume":"35","author":"Hanley","year":"2018","journal-title":"J Neurotrauma"},{"key":"2026080412431481700_usag371-B7","doi-asserted-by":"publisher","first-page":"S265","DOI":"10.1016\/j.apmr.2013.04.026","article-title":"Methodological issues and research recommendations for prognosis after mild traumatic brain injury: results of the international collaboration on mild traumatic brain injury prognosis","volume":"95","author":"Kristman","year":"2014","journal-title":"Arch Phys Med Rehabil"},{"key":"2026080412431481700_usag371-B8","doi-asserted-by":"publisher","first-page":"e2223245","DOI":"10.1001\/jamanetworkopen.2022.23245","article-title":"Outcomes in patients with mild traumatic brain injury without acute intracranial traumatic injury","volume":"5","author":"Madhok","year":"2022","journal-title":"JAMA Netw Open"},{"key":"2026080412431481700_usag371-B9","author":"Defense Health Agency","year":"2025"},{"key":"2026080412431481700_usag371-B10","doi-asserted-by":"publisher","first-page":"1133","DOI":"10.1089\/neu.2022.0103","article-title":"Military traumatic brain injury: the history, impact, and future","volume":"39","author":"Lindberg","year":"2022","journal-title":"J Neurotrauma"},{"key":"2026080412431481700_usag371-B11","first-page":"2","article-title":"The association of deployment-related probable traumatic brain injury with subsequent medical readiness status","volume":"32","author":"MacGregor","year":"2025","journal-title":"Med Surveill Month Rep"},{"key":"2026080412431481700_usag371-B12","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1111\/acem.13175","article-title":"Emergency department triage of traumatic head injury using brain electrical activity biomarkers: a multisite prospective observational validation trial","volume":"24","author":"Hanley","year":"2017","journal-title":"Acad Emerg Med"},{"key":"2026080412431481700_usag371-B13","doi-asserted-by":"publisher","first-page":"e2037349","DOI":"10.1001\/jamanetworkopen.2020.37349","article-title":"Validation of a machine learning brain electrical activity\u2013based index to aid in diagnosing concussion among athletes","volume":"4","author":"Bazarian","year":"2021","journal-title":"JAMA Netw Open"}],"container-title":["Military 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