Diagnostic Accuracy Studies in Mild Traumatic Brain Injury: A Systematic Review and Descriptive Analysis of Published Evidence

Abstract

Findings indicate that no well-defined definition or clinical diagnostic criteria exist for mTBI and that diagnostic accuracy is currently insufficient for discriminating between mTBI and co-occurring mental health conditions for acute and historic mTBI. Findings highlight the need for research examining the diagnostic accuracy for acute and historic mTBI.

Increased Rates of Mild Traumatic Brain Injury Among Older Adults in US Emergency Departments, 2009-2010

“…Prior studies have suggested that the CDC's ICD-9-CM codes for mild TBI surveillance have poor sensitivity to detect clinically defined mild TBI and that mild TBI is underdiagnosed. 10,13-16,37 In this study we used the CDC recommended ICD-9-CM codes for TBI of all severities in conjunction with the GCS and other criteria to isolate mild TBI. 5 These codes are recommended for national TBI surveillance and have been used to generate prior estimates against which we compare our results, suggesting that relative increases in observed rates should not be affected by the sensitivity of the ICD-9-CM codes or under diagnosis of mild TBI but we may be underestimating the absolute rates.…”

“…5,7 Diagnosis of mild TBI is difficult due to the absence of well-defined clinical criteria and among older adults is further complicated by the presence of comorbid conditions, medication use, and pre-injury cognitive impairment which can disguise symptoms of mild TBI. 8-10 Furthermore, age-related increases in intracranial space and anticoagulant use make bleeding more likely among older adults while at the same time decreasing the likelihood that GCS scores would indicate serious injury. 11,12 Consequently, mild TBI among older adults is most likely underdiagnosed.…”

“…11,12 Consequently, mild TBI among older adults is most likely underdiagnosed. 10, 13-16 This may have important consequences for older adults in terms of identification and treatment of functional and psychiatric sequelae of mild TBI. 17-23 Left untreated, these sequelae could lead to functional decline and potentially to loss of independence for the older adult.…”

Behavioral and inflammatory response in animals exposed to a low-pressure blast wave and supplemented with β-alanine

“…Most events leading to TBI/mTBI are also traumatic, and the symptoms associated with mTBI are at times difficult to distinguish clinically from post-traumatic stress disorder (PTSD) (Bryant et al 2010; Elder et al 2012; Ojo et al 2014; Pape et al 2013). Recently, it has been suggested that some neurocognitive effects associated with blast exposure, may be better explained by PTSD symptom severity rather than blast exposure, or mTBI history alone (Storzbach et al 2015).…”

Healthcare utilization following mild traumatic brain injury in female veterans

“…For mild TBI, a loss of consciousness cannot exceed 30 minutes, PTA cannot exceed 24 hours and the Glasgow Coma Scale (GCS) score must be less than 13 at the time of injury. While this definition of mild TBI, relative to the nine other published definitions, is more specific and most commonly reported in the literature, a welldefined set of clinical criteria to diagnose mild TBI and to clearly determine that symptoms are directly attributable to mild TBI does not exist [8][9][10]. Acute and persisting symptoms that manifest with mild TBI exposure are not unique to mild TBI, particularly in a combat-related exposure.…”