Recommendations for Diagnosing a Mild Traumatic Brain Injury: A National Academy of Neuropsychology Education Paper

Abstract

A special interest group of the American Congress of Rehabilitation Medicine [ACRM; Mild Traumatic Brain Injury Committee. (1993). Definition of mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 8 (3), 86-87.] was the first organized interdisciplinary group to advocate four specific criteria for the diagnosis of a mild traumatic brain injury (TBI). More recently, the World Health Organization (WHO) Collaborative Center Task Force on Mild Traumatic Brain Injury [Carroll, L. J., Cassidy, J. D., Holm, L., Kraus, J., & Coronado, V. G. (2004). Methodological issues and research recommendations for mild traumatic brain injury: the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Journal of Rehabilitation Medicine, (Suppl. 43), 113-125.] conducted a comprehensive review of the definitions utilized in evidence-based studies with mild TBI patients. Based on this review, the WHO task force maintained the same four criteria but offered two modifications. The similarities and differences between these two definitions are discussed. The authors of the ACRM and the WHO definitions do not provide guidelines or specific recommendations for diagnosing the four criteria. Thus, we provide recommendations for assessing loss of consciousness, retrograde and post-traumatic amnesia, disorientation and confusion as well as clarification of the neurologic signs that can be indicative of a diagnosis of mild TBI. Finally, confounding factors mentioned in both definitions that should exclude a mild TBI diagnosis are summarized.

Clinical and imaging assessment of acute combat mild traumatic brain injury in Afghanistan

“…Service members with mTBI were eligible if they met the diagnostic criteria for mTBI as defined by the American Congress of Rehabilitation Medicine 14 and sustained a blast exposure event within 7 days preceding enrollment. Controls were recruited from healthy, uninjured service members or service members receiving care for minor nonblast-related musculoskeletal injuries.…”

Functional Level During the First Year After Moderate and Severe Traumatic Brain Injury: Course and Predictors of Outcome

“…Exclusion criteria were age ≤ 16 years, TBI classified as mild (as defined by the American Congress of Rehabilitation Medicine (ACRM)) [11], vegetative state (no response indicative of consciousness during the rehabilitation stay), and serious co-morbidities which would have interfered with assessment of TBI related impairments such as associated spinal cord injuries, previously diagnosed severe psychological disorders, and/or substance abuse. Vegetative state was listed as an exclusion criterion since the Regional Committee for Medical Research Ethics did not approve written consent certified by a close relative if the patient was disabled from signing.…”

“…We included patients with moderate and severe TBI and excluded those with mild TBI. Mild TBI was defined by an initial GCS of 13 -15, change in mental status without loss of consciousness (LOC), or LOC up to 30 minutes and PTA up to 24 hours, as suggested by ACRM [11]. Moderate TBI was defined by GCS of 9 -12 and LOC more than 30 minutes, but less than 6 hours.…”

Detection of Mild Traumatic Brain Injury by Machine Learning Classification Using Resting State Functional Network Connectivity and Fractional Anisotropy

“…1 In spite of these evident symptoms, the World Health Organization and the National Academy of Neurology recognize that existing mTBI diagnosis methods require a thoughtful and deliberate approach, but provide limited evidence of their validity. 2,3 Further, mTBI produces long-term morbidity leading to psychiatric, neurologic, and psychosocial problems for some patients.…”