Difference between revisions of "Traumatic brain injury"
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===Mild TBI=== | ===Mild TBI=== | ||
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* Structural imaging is normal | * Structural imaging is normal | ||
* Loss of consciousness, if any, is less than 30 minutes | * Loss of consciousness, if any, is less than 30 minutes | ||
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===Moderate TBI=== | ===Moderate TBI=== | ||
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* Structural imaging may be normal or abnormal | * Structural imaging may be normal or abnormal | ||
* Loss of consciousness is more than 30 minutes but less than a day | * Loss of consciousness is more than 30 minutes but less than a day | ||
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===Severe TBI=== | ===Severe TBI=== | ||
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* Structural imaging may be normal or abnormal | * Structural imaging may be normal or abnormal | ||
* Loss of consciousness is greater than a day | * Loss of consciousness is greater than a day | ||
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''Eye opening'' | ''Eye opening'' | ||
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# no response | # no response | ||
# to pain | # to pain | ||
# to speech | # to speech | ||
# spontaneous | # spontaneous | ||
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''Verbal response '' | ''Verbal response '' | ||
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# no response | # no response | ||
# incomprehensible sounds | # incomprehensible sounds | ||
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# confused (sentences) | # confused (sentences) | ||
# oriented | # oriented | ||
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''Motor response'' | ''Motor response'' | ||
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# no response | # no response | ||
# extension to pain | # extension to pain | ||
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# obeys commands | # obeys commands | ||
| − | + | * Frontotemporal lobes of the brain are particularly susceptible to impact upon boney protuberances within the skull | |
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==Factors that influence outcomes== | ==Factors that influence outcomes== | ||
Revision as of 08:01, 17 April 2022
Contents
Diagnosis
Definition (as per CDC 2015 report to congress): disruption of normal brain function caused by a bump, blow, or jolt (such as with acceleration/deceleration movement) to the head or a penetrating head injury. Explosive blasts can also cause TBI. “Alteration of brain function” can include any one of the following:
- Any period of loss or decreased consciousness
- Any loss of memory for events immediately before (retrograde amnesia) or after the injury (post-traumatic amnesia)
- Neurologic deficits such as muscle weakness, loss of balance and coordination, disruption of vision, change in speech and language, or sensory loss
- Any alteration in mental state at the time of injury, such as confusion, disorientation, slowed thinking, or difficulty with concentration
Criteria for severity levels according to CDC report to congress:
Mild TBI
- Structural imaging is normal
- Loss of consciousness, if any, is less than 30 minutes
- Post-traumatic amnesia, if any, may occur in the day following head injury
- Best GCS within 24 hours is 13-15
Moderate TBI
- Structural imaging may be normal or abnormal
- Loss of consciousness is more than 30 minutes but less than a day
- Post-traumatic amnesia is typically greater than a day but less than a week
- Best GCS within 24 hours is 9-12
Severe TBI
- Structural imaging may be normal or abnormal
- Loss of consciousness is greater than a day
- Post traumatic amnesia is greater than a week
- Best GCS within 24 hours is 3-8
Glasgow coma scale
The GCS was first introduced by Teasdale and Jennett in an attempt to predict outcomes after severe head injury; it scores between 3-15 (Jennett et al, 1976)
Eye opening
- no response
- to pain
- to speech
- spontaneous
Verbal response
- no response
- incomprehensible sounds
- inappropriate words
- confused (sentences)
- oriented
Motor response
- no response
- extension to pain
- abnormal flexion to pain
- flexion / withdrawal to pain
- localizes pain
- obeys commands
- Frontotemporal lobes of the brain are particularly susceptible to impact upon boney protuberances within the skull
Factors that influence outcomes
Factors that influence outcomes according to CDC report to congress
- Individual characteristics
- Age (children < 7 years old who suffer moderate-severe TBI have substantially worse short and long-term outcomes; older adults have lower survival rates compared to young and middle-aged adults)
- Pre-injury functioning (higher pre-injury functioning tend to preserve more functional capacity)
- Social-environmental factors
- Socioeconomic status
- Caregiver and family functioning
- Social support
- Returning to participation in pre-injury social roles is an important aspect of functioning
- Factors such as living independently, maintaining employment, or be involved in meaningful interpersonal relationships can influence outcomes
- Access to care after hospitalization
- Discharge home (intensity of rehab not well defined) vs outpatient rehab vs inpatient rehab (most intense)
- Insurance
Additional modifiable risk factors associated with cognitive symptoms (Roberts, et al, 2021)
- High pain interference in daily life
- High anxiety symptoms
- High depressive symptoms
- Physical impairment
- Low physical activity
- Current smoking
- Short sleep duration
- Sleep apnea history
- Stroke, diabetes, hypertension, or cardiovascular history
Postconcussion syndrome
Postconcussion syndrome is discussed on a separate page.
Chronic traumatic encephalopathy
Chronic traumatic encephalopathy is discussed on a separate page.
Second impact syndrome
Second impact syndrome is discussed on a separate page.
References
Center for Disease Control and Prevention. Report to Congress on Traumatic Brain Injury in the United States: Epidemiology and Rehabilitation. (2015). https://pubmed.ncbi.nlm.nih.gov/26184889/
Jennett B, et al. Predicting outcome in individual patients after severe head injury. The Lancet 1031–1034 (1976). https://pubmed.ncbi.nlm.nih.gov/57446/
Roberts AL, et al. Modifiable risk factors for poor cognitive function in former American-style football players: findings from the Harvard football players health study. 2021. Journal of Neurotrauma 38:189-195. https://pubmed.ncbi.nlm.nih.gov/32640866/
