Mild traumatic brain injury defined by Glasgow Coma Scale: Is it really mild?

Joseph, Bellal; Pandit, Viraj; Aziz, Hassan; Kulvatunyou, Narong; Zangbar, Bardiya; Green, Donald J.; Haider, Ansab; Tang, Andrew; OʼKeeffe, Terence; Gries, Lynn; Friese, Randall S.; Rhee, Peter

doi:10.3109/02699052.2014.945959

Cited by 45 publications

(52 citation statements)

References 16 publications

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“…This statistic should be viewed as descriptive as GCS score at the time of injury is a singular, historical measure and there is the real possibility of cognitive decline after this point. 23 Additional data relating to this were not able to be retrieved in this retrospective study. …”

Section: Resultsmentioning

confidence: 97%

A Case-control Study Examining the Characteristics of Patients who Fall in an Inpatient Traumatic Brain Injury Rehabilitation Setting

McKechnie

Fisher

Pryor

2016

Journal of Head Trauma Rehabilitation

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A patient in the rehabilitation setting with a more severe TBI characterized by multisystem impairments is at an increased risk of falling, whereas some traditional fall risk factors were not associated with patients who fall. Rehabilitation settings should consider cohort-specific fall risk profiling. The Ontario STRATIFY Falls Risk Screening Tool is perhaps not the best tool to screen for falls in this inpatient population.

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Section: Resultsmentioning

confidence: 97%

A Case-control Study Examining the Characteristics of Patients who Fall in an Inpatient Traumatic Brain Injury Rehabilitation Setting

McKechnie

Fisher

Pryor

2016

Journal of Head Trauma Rehabilitation

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“…6 Research assessing prognostic factors in this TBI population have frequently used sample sizes based on convenience and lacked the statistical power to assess potential predictors simultaneously. 4,28 Our study was sufficiently powered to assess over 40 candidate variables in multi-variable modeling. Previous research found that initial GCS, type of brain injury, anticoagulation, and age were the strongest predictors of adverse outcomes in this population.…”

Section: Comparison Previous Literaturementioning

confidence: 99%

Development of a Clinical Decision Rule for the Early Safe Discharge of Patients with Mild Traumatic Brain Injury and Findings on Computed Tomography Brain Scan: A Retrospective Cohort Study

Marincowitz

Lecky

Allgar

et al. 2020

Journal of Neurotrauma

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International guidelines recommend routine hospital admission for all patients with mild traumatic brain injury (TBI) who have injuries on computed tomography (CT) brain scan. Only a small proportion of these patients require neurosurgical or critical care intervention. We aimed to develop an accurate clinical decision rule to identify low-risk patients safe for discharge from the emergency department (ED) and facilitate earlier referral of those requiring intervention. A retrospective cohort study of case notes of patients admitted with initial Glasgow Coma Scale 13-15 and injuries identified by CT was completed. Data on a primary outcome measure of clinically important deterioration (indicating need for hospital admission) and secondary outcome of neurosurgery, intensive care unit admission, or intubation (indicating need for neurosurgical admission) were collected. Multi-variable logistic regression was used to derive models and a risk score predicting deterioration using routinely reported clinical and radiological candidate variables identified in a systematic review. We compared the performance of this new risk score with the Brain Injury Guideline (BIG) criteria, derived in the United States. A total of 1699 patients were included from three English major trauma centers. A total of 27.7% (95% confidence interval [CI], 25.5-29.9) met the primary and 13.1% (95% CI, 11.6-14.8) met the secondary outcomes of deterioration. The derived clinical decision rule suggests that patients with simple skull fractures or intracranial bleeding <5 mm in diameter who are fully conscious could be safely discharged from the ED. The decision rule achieved a sensitivity of 99.5% (95% CI, 98.1-99.9) and specificity of 7.4% (95% CI, 6.0-9.1) to the primary outcome. The BIG criteria achieved the same sensitivity, but lower specificity (5%). Our empirical models showed good predictive performance and outperformed the BIG criteria. This would potentially allow ED discharge of 1 in 20 patients currently admitted for observation. However, prospective external validation and economic evaluation are required.

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“…By definition, these injuries are not associated with structural brain lesions, and in uncomplicated cases, do not typically warrant brain imaging examination (e.g., computed tomography, magnetic resonance imaging) or require inpatient hospitalization (41–43). Diagnostic assessment is often based on a single post-injury evaluation that may not adequately rule out rare cases of an evolving neurological event or potentially life-threatening sequelae [e.g., intracranial hemorrhage, second impact syndrome (SIS)] (44). As a practical matter, conceptualizing TBI as a dynamic neurological process focuses clinical attention on evaluation of a potentially fluctuating course rather than diagnosis of a static condition.…”

Section: Clarity Of Definitionsmentioning

confidence: 99%

“…By clinical convention, mild TBI is diagnosed in patients who have sustained a closed-head injury that results in a GCS score of 13–15 indicating minimal or no change in mental status (44). According to an influential American College of Rehabilitation Medicine (ACRM, 1993) position statement (45), mild TBI is defined as an alteration of brain function caused by external forces that results in one or more of the following clinical features: (i) change in mental status (confusion, disorientation, or slowed thinking), (ii) LOC lasting 0–30 min, (ii) post-traumatic amnesia (PTA) lasting less than 24 h; (iii) focal neurologic deficits that may or may not be transient, and (iv) GCS score of 13–15 at 30 min post-injury.…”

Section: Clarity Of Definitionsmentioning

confidence: 99%

Considerations for Experimental Animal Models of Concussion, Traumatic Brain Injury, and Chronic Traumatic Encephalopathy—These Matters Matter

et al. 2017

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Animal models of concussion, traumatic brain injury (TBI), and chronic traumatic encephalopathy (CTE) are widely available and routinely deployed in laboratories around the world. Effective animal modeling requires careful consideration of four basic principles. First, animal model use must be guided by clarity of definitions regarding the human disease or condition being modeled. Concussion, TBI, and CTE represent distinct clinical entities that require clear differentiation: concussion is a neurological syndrome, TBI is a neurological event, and CTE is a neurological disease. While these conditions are all associated with head injury, the pathophysiology, clinical course, and medical management of each are distinct. Investigators who use animal models of these conditions must take into account these clinical distinctions to avoid misinterpretation of results and category mistakes. Second, model selection must be grounded by clarity of purpose with respect to experimental questions and frame of reference of the investigation. Distinguishing injury context (“inputs”) from injury consequences (“outputs”) may be helpful during animal model selection, experimental design and execution, and interpretation of results. Vigilance is required to rout out, or rigorously control for, model artifacts with potential to interfere with primary endpoints. The widespread use of anesthetics in many animal models illustrates the many ways that model artifacts can confound preclinical results. Third, concordance between key features of the animal model and the human disease or condition being modeled is required to confirm model biofidelity. Fourth, experimental results observed in animals must be confirmed in human subjects for model validation. Adherence to these principles serves as a bulwark against flawed interpretation of results, study replication failure, and confusion in the field. Implementing these principles will advance basic science discovery and accelerate clinical translation to benefit people affected by concussion, TBI, and CTE.

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Mild traumatic brain injury defined by Glasgow Coma Scale: Is it really mild?

Cited by 45 publications

References 16 publications

A Case-control Study Examining the Characteristics of Patients who Fall in an Inpatient Traumatic Brain Injury Rehabilitation Setting

A Case-control Study Examining the Characteristics of Patients who Fall in an Inpatient Traumatic Brain Injury Rehabilitation Setting

Development of a Clinical Decision Rule for the Early Safe Discharge of Patients with Mild Traumatic Brain Injury and Findings on Computed Tomography Brain Scan: A Retrospective Cohort Study

Considerations for Experimental Animal Models of Concussion, Traumatic Brain Injury, and Chronic Traumatic Encephalopathy—These Matters Matter

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