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Thursday, December 15, 2011

All Brain Injuries are Not the Same: Part 2

Today’s blog entry is part 2 of yesterday’s blog entry about the reasons why it is important to distinguish mild traumatic brain injuries from moderate to severe traumatic brain injury as opposed to lumping them all together under the term “brain injury”. Further explanations as to how this distinction is important includes:

4. NEUROIMAGING: In moderate to severe TBI, the results of neuroimaging are critical to deciding how to manage the patient. For example, if a bleed is large enough, this might require neurosurgery to remove pressure on the brain. This sometimes requires repeat brain scans in the acute injury phase to monitor the size and effects of an intracranial lesion (e.g., a brain bleed). In MTBI cases, initial neuroimaging results in the ER do not show abnormalities between 90 to 95% of the cases. Thus, after an initial negative brain CT scan, clinical management of the MTBI patient is often based on subjective symptoms (e.g., headache) rather than objective findings.

5. COURSE: In moderate to severe TBI, the recovery course is well-defined and empirical, with the most drastic improvement occurring in the first six months, additional recovery over the next six months, and slower recovery up to 18 to 24 months. In mild TBI, the course of recovery is clear for the vast majority of people which would suggest that most recover within a week to a few months. However, the course of recovery for those who experience persisting symptoms (more than three months) is less clearly understood.

6. OUTCOME: As noted above, outcome is strongly related to acute injury characteristics in moderate to severe TBI cases and it is generally an exception when psychological factors confound outcome (although this certainly can occur). Conversely, in mild traumatic brain injury, outcome is poorly related to acute injury characteristics. Rather, non-injury related factors tend to be the most predictive of outcome. Examples of non-injury factors include litigation/compensation-seeking, psychological distress, pre-injury psychiatric history, post-injury stressors, substance abuse, and various other psychosocial issues.

7. DISABILIY: In moderate to severe TBI, disability (a form of outcome) is more clearly attributed to injury severity, the functional neuroanatomy of the injury, and resulting impairments. In mild TBI, there is a less clear association between the clinical presentation of the patient and the degree to which neurological and psychological factors play a role.

These examples show that one cannot speak of traumatic brain injury as if it has the same meaning across the severity spectrum. The media and health care providers are strongly encouraged to clearly distinguish between mild and moderate to severe brain injuries when discussing this topic with patients and the public.

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