Traumatic Brain Injury

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Definition
Traumatic brain injury (TBI) is a nondegenerative, noncongenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or altered state of consciousness. The definition of TBI has not been consistent and tends to vary according to specialties and circumstances. Often, the term brain injury is used synonymously with head injury, which may not be associated with neurologic deficits. The definition also has been problematic with variations in inclusion criteria. Glasgow Coma Scale

The Glasgow Coma Scale (GCS) defines the severity of a TBI within 48 hours of injury. * Spontaneous = 4
* To speech = 3
* To painful stimulation = 2
* No response = 1
Motor response
* Follows commands = 6
* Makes localizing movements to pain = 5
* Makes withdrawal movements to pain = 4
* Flexor (decorticate) posturing to pain = 3
* Extensor (decerebrate) posturing to pain = 2
* No response = 1
Verbal response
* Oriented to person, place, and date = 5
* Converses but is disoriented = 4
* Says inappropriate words = 3
* Says incomprehensible sounds = 2
* No response = 1
The severity of TBI according to the GCS score (within 48 h) is as follows: * Severe TBI = 3-8
* Moderate TBI = 9-12
* Mild TBI = 13-15
Ranchos Los Amigos Scale of Cognitive Functioning
The severity of deficit in cognitive functioning can be defined by the Ranchos Los Amigos Scale. * level I = No response
* level II = Generalized response
* level III = Localized response
* level IV = Confused-agitated
* level V = Confused-inappropriate
* level VI = Confused-appropriate
* level VII = Automatic-appropriate
* level VIII = Purposeful-appropriate
TBI defined by the Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine The Head Injury Interdisciplinary Special Interest Group of the American Congress of Rehabilitation Medicine defines mild head injury as "a traumatically induced physiologic disruption of brain function, as manifested by one of the following: * Any period of loss of consciousness (LOC),

* Any loss of memory for events immediately before or after the accident, * Any alteration in mental state at the time of the accident, * Focal neurologic deficits, which may or may not be transient." The other criteria for defining mild TBI include the following: * GCS score greater than 12

* No abnormalities on computed tomography (CT) scan
* No operative lesions
* Length of hospital stay less than 48 hours
The following criteria define moderate TBI:
* Length of stay at least 48 hours
* GCS score of 9-12 or higher
* Operative intracranial lesion
* Abnormal CT scan findings
The National Institutes of Health Traumatic Coma Data Bank
The National Institutes of Health (NIH) sponsored the Traumatic Coma Data Bank (TCDB).[1] The TCDB revealed that severe TBI is indicated when the GCS score is below 9 within 48 hours of the injury. Simplified Motor Score (SMS)

The SMS is a 3-point scale developed to address the perceived limitations of the GCS, such as its complexity and poor interrater reliability. The points are as follows: * Obeys commands = 2 points

* Localizes pain = 1 point
* Withdraws to pain or worse = 0 points

Epidemiology
Inconsistency in the definition and classification of traumatic brain injury (TBI), along with discrepancies in data collection, has made the epidemiology of TBI difficult to describe accurately. Problems with TBI data collection include the fact many patients with mild TBI may not present to the hospital, and the ones who do present may be discharged at the emergency department (ED) without adequate documentation. Severe TBI with associated death at the scene of the accident or during transport to a...
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