I once heard a comedian say that a “mild” heart attack is one that happens to somebody else. Boy, isn’t that true! Because when it happens to you it is anything but “mild”.
Does the same logic hold true for a brain injury? Does a “mild” brain injury only happen to somebody else? The answer is no. But, surprisingly, you may not even know that you have a mid traumatic brain injury. And, more surprisingly, the emergency room where you are seen may not be able to tell you that you have one.
Now, before we continue, we need to understand the difference between a “head” injury and a “brain” injury. You may hear the terms used interchangeably, but they are very different. A head injury is one that is clinically evident on physical examination – you can see it. There are cuts, bumps, bruises, blood – visible evidence that an injury has occurred. A brain injury, on the other hand, refers specifically to injury to the brain itself that cannot be seen by the naked eye on physical examination and is often not clinically evident. The distinction between a head injury and a mild traumatic brain injury is critically important because when a brain injury goes undiagnosed 5% to 15% of patients may have compromised function one year or more after their injury.
Realizing that many mild traumatic brain injuries do go undiagnosed because there is no apparent head injury, The Centers for Disease Control (CDC) and the American College of Emergency Physicians (ACEP) convened a multidisciplinary panel to revise clinical diagnosis guidelines to help improve the diagnosis, treatment, and patient outcomes for mild traumatic brain injury patients. With more than one million emergency department visits annually for brain injuries in the United States alone, the impact of an undiagnosed brain injury can be tremendous.
Generally, the diagnosis of a mild traumatic brain injury can be made when at least one of the following criteria has been met:
1) Any period of loss of consciousness lasting 30 minutes or less
2) Any period of observed or self reported dysfunction of memory (amnesia) around the time of the injury
3) Any alteration of mental state at the time of the injury (feeling dazed, confused, disoriented)
The challenge of the emergency room physician and nursing staff is identifying which patients with a probable mild traumatic brain injury require extended diagnostic treatment to prevent further damage and which patients can be safely sent home. The revised diagnostic guidelines answer the additional critical questions:
Which patients with mild traumatic brain injury should have a non-contrast head CT scan in the Emergency Department?
Is there a role for head MRI over non-contrast CT in the Emergency Department evaluation of a patient with acute mild traumatic brain injury?
In patients with mild traumatic brain injury, are brain-specific serum biomarkers predictive of an acute traumatic intracranial injury?
Can a patient with an isolated mild traumatic brain injury and a normal neurologic result be safely discharged from the Emergency Department if a non-contrast head CT sc an shows no evidence of intracranial injury?
It is widely believed that these new and enhanced guidelines will make a difference in the diagnosis and early treatment of brain injuries. For more information on the new guidelines, visit http://www.acep.org/practres.aspx?id=8814
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Personal Injury Blog |