Mild traumatic brain injury

Abstract

Traumatic brain injury (TBI) is one among the most frequent neurological disorders. Of all TBIs 90% are considered mild with an annual incidence of 100-300/100 000. Intracranial complications of mild traumatic brain injury (MTBI) are infrequent (10%), requiring neurosurgical intervention in a minority of cases (1%), but potentially life threatening (case fatality rate 0.1%). Hence, a true health management problem exists because of the need to exclude the small chance of a life-threatening complication in a large number of individual patients. The 2002 EFNS guideline used the best evidence approach based on the literature until 2001 to guide initial management with respect to indications for computed tomography (CT), hospital admission, observation and follow-up of MTBI patients. This updated EFNS guideline for initial management in MTBI proposes a more selective strategy for CT when major [dangerous mechanism, Glasgow Coma Scale (GCS) < 15, 2 points deterioration on the GCS, clinical signs of (basal) skull fracture, vomiting, anticoagulation therapy, post-traumatic seizure] or minor (age, loss of consciousness, persistent anterograde amnesia, focal deficit, skull contusion, deterioration on the GCS) risk factors are present based on published decision rules with a high level of evidence. In addition, clinical decision rules for CT now exist for children as well. Since 2001, recommendations, although with a lower level of evidence, have been published for clinical observation in hospitals to prevent and treat other potential threats to the patient including behavioural disturbances (amnesia, confusion and agitation) and infection.

ED disposition of the Glasgow Coma Scale 13 to 15 traumatic brain injury patient: analysis of the Transforming Research and Clinical Knowledge in TBI study

“…It is commonly recommended that a patient with a negative head CT and a GCS of 15 may be safely discharged from the ED [3–5,7]. In contrast, if the head CT shows any traumatic ICH, many centers opt to admit the patient to an ICU setting [24,29,30].…”

Post-concussive complaints after mild traumatic brain injury associated with altered brain networks during working memory performance

“…Fifty-five patients (age 18–65 years old) with mTBI were prospectively included at the University Medical Center Groningen, The Netherlands (a level 1 trauma center) between March 2013 and February 2015. The diagnosis of mTBI was based on a Glasgow Coma Score of 13–15 and/or loss of consciousness ≤30 min (Vos et al 2012). The following exclusion criteria were applied: lesions on admission computed tomography (CT) scans, neurological or psychiatric comorbidity, prior admission for TBI, drug or alcohol abuse, mental retardation and contraindications for MRI (implanted ferromagnetic devices or objects, pregnancy or claustrophobia).…”

Predictors of new-onset seizures: a 10-year follow-up of head trauma subjects with and without traumatic brain injury

“…The last-mentioned category included all subjects who presented with Glasgow Coma Scale (GCS) <13 and also subjects with brain contusion, diffuse axonal injury, traumatic subarachnoid haemorrhage and traumatic intracranial haematomas regardless of their GCS score or need for surgery. Mild TBI included subjects with GCS scores of 13–15 and LOC <30 min or post-traumatic amnesia (PTA) <1 h in the absence of traumatic intracranial findings in a brain CT/MRI 9. Subjects without a brain CT/MRI were also classified as having TBI if any other criteria for mild TBI were fulfilled.…”