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 poten tially 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 man agement with respect to indications for computed tomography (CT), hospital admis sion, 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, recommen dations, 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.

Return to play management after concussion in football: recommendations for team physicians

“…The decision on a safe RTP is in the responsibility of the team physician and should follow an individualized and gradual step-wise rehabilitation programme. Distribution of information and education on characteristics of concussion of Giza et al, 2013, Harmon et al, 2013and Vos et al, 2012 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 …”

“…However, the team physician has to keep in mind, that intracerebral haemorrhage or oedema can develop within hours, for instance, an extradural haematoma within 6 hours. Thus the initial CT may be false negative when performed very early (within 1 h) (Smith & Miller, 1991;Vos et al, 2012).…”

Demographic Profile and Pathological Patterns of Head Injury in Albania

“…In addition, the emotion recognition test could be the only index that is significantly related to post-traumatic amnesia duration, GCS score, and the presence of prefrontal lesions [14]. Radiological abnormalities correlate with consciousness alteration, the presence of vomiting, amnesia, as predictors of abnormal computerized tomography even in patients with normal GCS score [15,16].…”

Outpatient follow-up after mild traumatic brain injury: Results of the UPFRONT-study

“…First, hospitalized patients are more severely injured [6], and second, since guidelines recommend different aftercare following mTBI after hospitalization or direct discharge, it is probable that different follow-up pathways exist. The decision whether a mTBI patient has to be admitted to the hospital ward (or Intensive Care Unit) has been studied in various mTBI cohorts, which has led to European guidelines for ED treatment, admission and followup for this patient category [6,7]. Outpatient follow-up in the sub-acute phase after injury is recommended at least once for hospitalized patients.…”