In world of TBI, classification of severity key to successful treatment


Not all brain injuries are created — of manifest — equally. There remains no unflinching set of standards by which all diagnoses can neatly obey and no cranium reciprocal enough to cram or withstand every ill blow that could possibly befall it or any other. Thus, in the realm of TBI, physicians enter a tricky diagnostic space.

[See also: Consistent levels of brain abnormality discovered in mTBI patients]

“The important thing to remember is that not all brain injuries are alike. Just as not all individuals are alike, injuries in the brain are not all alike,” James R. Sisung II, Psy. D, from VA Maine Healthcare, began in his workshop on traumatic brain injury during the New England Clinical Symposium — pinpointing why exactly it’s often difficult for physicians to come to a clinical conclusion regarding TBIs.

While symptoms can be subtle, the differences between the affects of a mild traumatic brain injury, moderate brain damage, and severe head injury are drastic.

Sisung shared three indexes that are currently available to help assist professionals when gauging the severity of a brain injury: The Glasgow Coma Scale (GCS), the duration of loss of consciousness (LOC) measurement, and the duration of post-traumatic amnesia (PTA) calculator (Current industry definitions for each TBI classification in conjunction with the three scales can be seen in Sisung’s table below).

Mild

Moderate

Severe

LOC < 30 mins

LOC < 6 hours

LOC > 6 hours

- CT/MRI

+ or – CT/MRI

+ or – CT/MRI

GCS 13-15

GCS 9-12

GCS < 9

PTA < 24 hours

PTA < 7 days

PTA > 7 days

[See also: AOA survey explores patient concussion mindsets, apprehensions]

Because each of the above TBI classification represents a different gradation of treatment, it’s important to classify the assumed severity of the brain injury in discussions with other professionals and the patients themselves, Sisung noted.

“The expected nature, severity and course of symptoms following a moderate or severe brain injury are much different than what is expected following a mild traumatic brain injury,” he said. “It is inappropriate to refer to an individual as having a brain injury without specifying the severity of the injury.”

Physicians, when discussing a patient’s mTBI condition with that client, should outline severities in a way that is honest, yet not overtly threatening.

“An analogy with a simpler, less threatening type of injury” works well, Sisung said. “A simple ankle sprain versus more serious (e.g. fracture) or permanent injuries of the leg” was one key example of this that Sisung shared.

Enough reassurance, especially with those who have suffered from an mTBI/concussion, could determine whether or not a patient deals with post-concussive symptoms, such as those listed by Sisung below:

Physiological

Headache, dizziness, vomiting, loss of balance, poor coordination, fatigue, weakness

Cognitive

Confusion, poor attention/concentration, forgetfulness, slowed thinking, difficulty making decisions

Affective

Depression, anxiety, irritability, agitation, poor frustration tolerance, sleep disturbance

Sensory

Light/noise sensitivity, blurred vision, hearing loss, numbness, altered taste or smell

“Studies have shown that patients who believe their concussions will cause lasting symptoms are more likely to have symptoms, which is why it is so important to provide reassurance and education that promote the expectation of rapid recovery,” Sisung concluded. 

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