Mild traumatic brain injury

Revision as of 22:33, 21 July 2016 by Neil.m.young (talk | contribs) (Text replacement - "==Diagnosis==" to "==Evaluation==")

Background

Mild TBI.JPG
  • Concussion (mild TBI) is defined as GCS 14-15 with assoc signs or symptoms after a blunt force or acceleration-deceleration head injury
  • Types
    • Simple concussion
      • Gradual resolution of symptoms within 7-10d
    • Complex concussion
      • Persisting symptoms or cognitive impairment
      • Symptoms with exertion

Evaluation

  • Any alteration in the mental state at the time of event or subsequent to the event
    • Symptoms may be delayed by days-weeks
  • Most consistent abnormality is subtle impairments in cognitive function
    • Attention, concentration, memory, processing speed, reaction time
  • Physical signs/symptoms
  • Behavioral changes
    • Irritability, depression, anxiety, sleep disturbances, problems related to school/work

Differential Diagnosis

Intracranial Hemorrhage Types

Evaluation

  • Based on history and clinical evaluation

Management

  • Simple
    • Limitations on playing and training while symptomatic
    • Follow up with primary care provider
  • Complex
    • Refer to sports medicine or concussion specialist

Disposition

  • Upon discharge from the ER all patients with a diagnosis of concussion should receive educational materials on activities to avoid and symptoms to anticipate during recovery as those who received it have better long-term outcomesials[1]
  • Recommend strict rest for 1-2 days with gradual introduction back to regular activity[2]

Prognosis

  • At 3 mo after injury <30% are symptomatic
  • At 1 yr after injury 15% are symptomatic

See Also

References

  1. Ronsford J, et al. Impact of early intervention on outcome after mild traumatic head in adults. 2002
  2. Thomas DG, Apps JN, Hoffmann RG, et al. Benefits of strict rest after acute concussion: a randomized controlled trial. Pediatrics. 2015; 2(135):213-223.