16 The overlap of MTBI symptoms with those of other disease processes in patients who may have extenuating circumstances can complicate a workup. 8, 15 Postconcussive symptoms are equally prevalent in patients with MTBI and non–head injury trauma. They also occur in persons who do not have a traumatic brain injury, but who may have mental health disorders, chronic pain syndromes, and other disease processes. 8 Use of the term postconcussive syndrome should be discouraged because many of the symptoms are subjective and difficult to predict consistently. 13, 14 The precise incidence is debatable, largely because of disparity in definitions and overlap with other conditions. 12 Traumatic brain injury is described as the signature injury of military personnel serving in Operation Enduring Freedom and Operation Iraqi Freedom, with as many as 15 percent of combatants experiencing this type of injury. In the United States, direct and indirect costs of MTBI in 2000 were estimated to be $12 billion. Sleep hygiene education, light desensitization, sunglasses Vision problems (e.g., blurring, photophobia) Mental health, neurology, or physical medicine and rehabilitation referral

Hearing problems (e.g., sensitivity to noise)Īudiology or ENT referral speech and language pathology referral for patients with sensitivity to noise Sleep hygiene education, physical therapy, relaxation Non-narcotic analgesics, nonsteroidal anti-inflammatory drugs triptans (for migraine) Referral considerations if poor response to treatment †Īntibiotics, decongestants for middle ear infections and fluidĮNT referral neurology referral after ENT interventions Specifically uses terms concussion and mild traumatic brain injury interchangeably

Symptoms must not be related to penetrating head injury, intoxicants or other medications, or other diagnosesĭefinition specifically for concussion in sports concussion may also occur with impulsive force transmitted to the head Grades 1–2, none grade 3, seconds to minutesĭefinition specifically for concussion in sports symptoms may be divided into early and late categories, and may vary from case to case Initial score of 13 to 15, 30 minutes after injury or later on presentation to care Posttraumatic amnesia for less than one day Grade 1, posttraumatic amnesia 15 minutes Posttraumatic amnesia less than 24 hours any retrograde amnesia Department of Veterans Affairs/Department of Defense 8Īltered mental status or alteration of consciousness (e.g., feeling dazed, disoriented, confused) Psychiatric and medical comorbidities, psychosocial issues, and legal or compensatory incentives should be explored in patients resistant to treatment.Īmerican Congress of Rehabilitation Medicine 3Ĭenters for Disease Control and Prevention 7 Symptom-specific treatment, gradual return to activity, and multidisciplinary coordination of care lead to the best outcomes. Early patient and family education should include information on diagnosis and prognosis, symptoms, and further injury prevention. The diagnostic workup for subacute to chronic mild traumatic brain injury focuses on the history and physical examination, with continuing observation for the development of red flags such as the progression of physical, cognitive, and behavioral symptoms, seizure, progressive vomiting, and altered mental status. Women, older adults, less educated persons, and those with a previous mental health diagnosis are more likely to have persistent symptoms. Cognitive and behavioral symptoms include fatigue, anxiety, depression, and irritability, and problems with memory, concentration and decision making. Physical symptoms include headaches, dizziness, and nausea, and changes in coordination, balance, appetite, sleep, vision, and hearing. Persistent physical, cognitive, or behavioral postconcussive symptoms may be noted in 5 to 20 percent of persons who have mild traumatic brain injury. Most patients recover quickly, with a predictable clinical course of recovery within the first one to two weeks following traumatic brain injury. Although a universally accepted definition is lacking, mild traumatic brain injury and concussion are classified by transient loss of consciousness, amnesia, altered mental status, a Glasgow Coma Score of 13 to 15, and focal neurologic deficits following an acute closed head injury.

Post traumatic amnesia treatment