LAUSR

SARS-CoV-2 or COVID-19 caused the pandemic that was declared by the WHO on 11 March 2020. The current coronavirus pandemic resulted in overwhelming numbers of patients presenting to the emergency department and unprecedented care requirements. Health systems in several countries were on the verge of collapse, not to mention the economic downturn. The mandatory quarantine and restrictions in daily living, implemented by several countries, have been proven to reduce traumatic brain injury (TBI) cases significantly [1]. However, in relation to the mechanism of injury, a relative increase in low-impact falls at home was seen [1]. Mild TBI is the most common form of TBI, accounting for 70–90% of all brain injuries. The estimated incidence is about 600 cases per 100,000 of the population, being more common in males and young adults [2]. In patients presenting with a Glasgow Coma Scale score of 15, about 5% of CT scans have pathological findings, whereas in patients over 65 years of age, 11–21% may have findings consistent with intracranial trauma. Haydel et al. reported that 17% of adults over 60 years of age with a normal Glasgow Coma Scale at admission had a positive head CT [3]. Neurosurgical intervention is required in approximately 1% of mild TBI patients. The epidemiology pattern of TBI has changed in recent years, with falls in the elderly increasing significantly, mainly in high-income countries [4]. In children, 640,000 visits per year to the emergency department have been reported in the USA. Falls and being struck by an object were the most common causes in the younger age group, whereas motor accidents and falls were the most frequent in the older groups [5]. Indiscriminate use of CT is associated with high cost and risk of radiation exposure, especially in children. A study that evaluated cancer risk in 680,000 children and adolescents that were exposed to a diagnostic CT found a 24% higher cancer incidence in exposed people [6]. MRI in the acute setting has also been investigated and is currently used in some institutes [7]. Roguski et al. evaluated 35 children with TBI that underwent both CT and MRI examinations within a 5-day period, and found that MRI can be a useful alternative to CT. Nevertheless, MRI missed skull fractures in five out of 13 cases [8]. Thus, physicians must decide which patient are in need of neuroimaging, which should be observed, and which can be discharged home. Several prediction rules to identify patients requiring a CT scan have been developed, however usage in clinical practice is variable or requires external validation. During a pandemic, the identification of patients with mild TBI in need of CT and possible hospitalization is of paramount importance. First, the detection of patients in need of hospitalization would help minimize long waiting hours in the emergency department, in which there is a risk of virus transmission [9]. This would facilitate the transfer of the patient to a hospital capable of providing CT scans or neurosurgical intervention. Furthermore, some may choose to avoid emergency care, which may in turn delay treatment for new and concerning symptoms. The mechanism by which these biomarkers are transported outside the brain is still under investigation. Several biomarkers in blood, corticospinal fluid, saliva or urine have been investigated in this regard [10]. TBI is known to