![]() ![]() The severity of TBI can also be categorized by the duration of LOC and PTA, measures that are reported to have better correlation with patient outcome than GCS ( Forde et al., 2014). Advancing age, particularly over the age of 60 years, is also associated with an increased risk of a poor outcome ( Hukkelhoven et al., 2006) (Ch. In the lower ranges of GCS score (3–9), primarily associated with severe TBI, there is a direct linear relation to a poor outcome, including severe neurologic disability, vegetative state, and death. Patients with severe TBI are at high risk for secondary brain injury including hypotension, hypoxemia, and brain swelling ( Hukkelhoven et al., 2006). In moderate traumatic brain injury (GCS 9–13), the patient is initially lethargic or stuporous, and in severe TBI (GCS 3–8), the patient is comatose, unable to open the eyes or follow commands. The true frequency of concussion is likely far greater because concussions are routinely under-recognized, under-reported and typically resolve spontaneously without medical care. Concussion is especially frequent in American football, where 4.5% of high school, 6.3% of collegiate, and 6.6% of professional football players are diagnosed with at least one concussion per season ( Pellman et al., 2004 Daneshvar et al., 2011a). In the US, it is estimated that 1.6–3.8 million concussions occur annually ( Langlois et al., 2006). There is often full neurologic recovery after mTBI however, 15–30% of subjects develop prolonged neurocognitive and behavioral changes ( Daneshvar et al., 2011b) (Ch. Mild TBI occurs in a wide variety of activities including sports, such as boxing, American football, rugby, soccer, cheerleading, ice hockey, and wrestling military service and in association with other exposures such as poorly controlled epilepsy, head banging, and physical abuse ( Daneshvar et al., 2011a). Mild TBI includes concussion as well as subconcussion and some blast injuries associated with improvised explosive devices. Of all severities of TBI, an estimated 75–85% are categorized as mild TBI (mTBI) with a GCS score of 13 to 15 ( CDC, 2003). ![]() The major advantage of the GCS is its simplicity and its usefulness as a standardized measurement that can be used to compare outcomes across a series of patients ( Teasdale and Jennett, 1974). The GCS is used to grade TBI as mild, moderate, or severe ( Table 4.1) ( Teasdale and Jennett, 1974). ![]() All grades of TBI can be associated with long-term physical, emotional, behavioral, and cognitive consequences that permanently affect an individual's ability to perform routine activities and return to work ( Langlois et al., 2006 Daneshvar et al. Although prognosis is often predicted based on measured clinical severity, the extent to which each of these severity assessments correlates with outcome is less clear. The most commonly used assessment scales, the Glasgow Coma Scale (GCS) score and the duration of LOC or PTA, use clinical assessment to grade the severity of the trauma. The severity of TBI can be quantified using a variety of measures. The US Department of Veterans Affairs and the Department of Defense's Clinical Practice Guideline For Management of Concussion/mTBI (version 1.0, April 2009) defines TBI asĪ traumatically induced structural injury and/or physiologic disruption of brain function as a result of an external force that is indicated by new onset or worsening of at least one of the following clinical signs, immediately following the event: any period of loss of or a decreased level of consciousness (LOC), any loss of memory for events immediately before or after the injury (post-traumatic amnesia ), any alteration in mental state at the time of the injury (confusion, disorientation, slowed thinking, etc.), neurologic deficits (weakness, loss of balance, change in vision, praxis, paresis/plegia, sensory loss, aphasia, etc.) that may or may not be transient, or intracranial lesion. Traumatic brain injury (TBI) occurs when a force transmitted to the head or body results in neuropathologic damage and dysfunction. ![]()
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