Position Statement: Definition of Traumatic Brain Injury

University of Cambridge, United Kingdom.
Archives of physical medicine and rehabilitation (Impact Factor: 2.57). 11/2010; 91(11):1637-40. DOI: 10.1016/j.apmr.2010.05.017
Source: PubMed


A clear, concise definition of traumatic brain injury (TBI) is fundamental for reporting, comparison, and interpretation of studies on TBI. Changing epidemiologic patterns, an increasing recognition of significance of mild TBI, and a better understanding of the subtler neurocognitive neuroaffective deficits that may result from these injuries make this need even more critical. The Demographics and Clinical Assessment Working Group of the International and Interagency Initiative toward Common Data Elements for Research on Traumatic Brain Injury and Psychological Health has therefore formed an expert group that proposes the following definition: In this article, we discuss criteria for considering or establishing a diagnosis of TBI, with a particular focus on the problems how a diagnosis of TBI can be made when patients present late after injury and how mild TBI may be differentiated from non-TBI causes with similar symptoms. Technologic advances in magnetic resonance imaging and the development of biomarkers offer potential for improving diagnostic accuracy in these situations.

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    • "Using the established guidelines (summarized in Table 9.1), accurate diagnosis of mild TBI is still a challenge because of the frequent presence of confounding factors (Menon et al., 2010). In many cases, clinicians rely on LOC or PTA that is self-reported and unreliable or from fragmented information from witnesses. "
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    ABSTRACT: Mild traumatic brain injury (TBI) is common but accurate diagnosis and defining criteria for mild TBI and its clinical consequences have been problematic. Mild TBI causes transient neurophysiologic brain dysfunction, sometimes with structural axonal and neuronal damage. Biomarkers, such as newer imaging technologies and protein markers, are promising indicators of brain injury but are not ready for clinical use. Diagnosis relies on clinical criteria regarding depth and duration of impaired consciousness and amnesia. These criteria are particularly difficult to confirm at the least severe end of the mild TBI continuum, especially when relying on subjective, retrospective accounts. The postconcussive syndrome is a controversial concept because of varying criteria, inconsistent symptom clusters and the evidence that similar symptom profiles occur with other disorders, and even in a proportion of healthy individuals. The clinical consequences of mild TBI can be conceptualized as two multidimensional disorders: (1) a constellation of acute symptoms that might be termed early phase post-traumatic disorder (e.g., headache, dizziness, imbalance, fatigue, sleep disruption, impaired cognition), that typically resolve in days to weeks and are largely related to brain trauma and concomitant injuries; (2) a later set of symptoms, a late phase post-traumatic disorder, evolving out of the early phase in a minority of patients, with a more prolonged (months to years), sometimes worsening set of somatic, emotional, and cognitive symptoms. The later phase disorder is highly influenced by a variety of psychosocial factors and has little specificity for brain injury, although a history of multiple concussions seems to increase the risk of more severe and longer duration symptoms. Effective early phase management may prevent or limit the later phase disorder and should include education about symptoms and expectations for recovery, as well as recommendations for activity modifications. Later phase treatment should be informed by thoughtful differential diagnosis and the multiplicity of premorbid and comorbid conditions that may influence symptoms. Treatment should incorporate a hierarchical, sequential approach to symptom management, prioritizing problems with significant functional impact and effective, available interventions (e.g., headache, depression, anxiety, insomnia, vertigo). © 2015 Elsevier B.V. All rights reserved.
    Handbook of Clinical Neurology 12/2015; 127C:131-156. DOI:10.1016/B978-0-444-52892-6.00009-X
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    • "Team sports injuries (e.g., hockey, football) have been identified as the main source of TBI among youth, while falls and motor vehicle collisions are the main mechanisms of TBI among adults (Centre for Disease Control and Prevention, 2010; Coronado et al., 2011; Gilchrist, 2011; Ilie et al., 2013, 2015; Zernicke et al., 2009). TBI is a condition characterized by change in brain function that is caused by a hit or blow to the head by an external force (Menon et al., 2010). TBIs, including milder forms of the injury, may have disabling clinical outcomes (Coronado et al., 2011; Finkelstein et al., 2000; Ilie et al., 2013, 2014a,b; 2015; Dematteo et al., 2010). "
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    ABSTRACT: Objective: This study describes the association between lifetime traumatic brain injury (TBI) and attention deficit and hyperactivity disorder (ADHD) among Canadian adults. Method: A cross-sectional sample of 3993 Ontario adults aged 18 or older were surveyed by Computer Assisted Telephone Interviewing (CATI) throughout 2011 and 2012 as part of the CAMH Monitor, a rolling survey assessing the health, mental health and substance use of Ontario adults. TBI was defined as trauma to the head that resulted in loss of consciousness for at leastfive minutes or overnight hospitalization. ADHD was measured by the 6-item ASRS screener for adult ADHD, and self-reported history of diagnosed ADHD. Results: Among adults with a history of TBI, 6.6% (95% CI: 4.7, 9.4) screened ADHD positive, and 5.9% (95% CI: 3.6, 9.5) reported having been diagnosed with ADHD in their lifetime. Adults with lifetime TBI had significantly greater odds of scoring positive on the ADHD/ASRS screen (OR¼ 2.49, 95% CI: 1.54, 4.04), and of reporting a history of diagnosed ADHD (OR¼ 2.64, 95% CI: 1.40, 4.98) than without TBI, when holding values of sex, age, and education constant. Conclusion: Significant positive associations between lifetime TBI and both current and past ADHD were observed among adults in this population. More research to understand these associations, and their significance for the etiology and management of TBI and ADHD, is needed
    Journal of Psychiatric Research 08/2015; DOI:10.1016/j.jpsychires.2015.08.004 · 3.96 Impact Factor
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    • "Traumatic brain injury occurs when an external force causes an alteration in brain functions such as decreased level of consciousness , loss of memory, neurological deficits or any alteration in mental state at the time of the injury [8]. The diagnosis of TBI necessarily involves a severity assessment [9]. "
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    ABSTRACT: L’occurrence d’un traumatisme craniocérébral (TCC) est un problème de santé publique majeure. Les troubles du sommeil et de l’éveil sont parmi les symptômes les plus persistants et les plus déshabilitants à la suite d’un TCC. Or, les études empiriques portant sur l’apparition de ces symptômes, leur chronicisation et leur traitement demeurent non concluantes. Cette revue narrative a comme but de recenser le niveau de connaissance actuel sur la nature (objective et subjective) des troubles du sommeil et de l’éveil chez les patients TCC, en tenant compte de la sévérité du traumatisme et de la phase de rétablissement. Un but secondaire est de cibler les causes potentielles de ses perturbations. En général, bien que la présence de troubles du sommeil et de l’éveil dans toutes les études conduites auprès de patients TCC soit observée indépendamment de la sévérité du traumatisme, des signes objectivables de la présence de telles perturbations ne sont pas rapportés de façon consistante dans ces études. Des études supplémentaires semblent être requises afin de mieux comprendre la complexité des troubles du sommeil et de l’éveil chez les patients TCC et d’optimiser la récupération à court et à long terme chez cette clientèle par l’entremise d’interventions ciblées.
    Pathologie Biologie 10/2014; 62(5). DOI:10.1016/j.patbio.2014.05.014 · 1.20 Impact Factor
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