Mild traumatic brain injury

Mild traumatic brain injury (TBI) is a closed head injury due to a direct blow to the head or deceleration of the head from an impulsive force, resulting in a transient change in mental status.

All patients with suspected traumatic brain injury should be assessed and stabilised using an Airway, Breathing, Circulation (ABC) approach.

An urgent (within 1 hour) computed tomographic (CT) head scan should be performed in those identified as having a risk factor for brain injury (i.e., intracranial complication). Consider a CT scan within 8 hours of the head injury, or within the hour if the patient presents more than 8 hours after the injury, in adults and children on anticoagulant treatment or antiplatelet treatment (excluding aspirin monotherapy), who have no other indications for a CT head scan.

Diagnosis of mild traumatic brain injury is clinical. Selected patients may be admitted to hospital for observation.

Patients with no indications for CT scan or with a normal CT scan may be discharged from the accident and emergency department if there is somebody suitable at home to supervise them.

The need for analgesia and antiemetics should be considered in all patients.

A mild traumatic brain injury is a head injury due to a direct blow to the head or deceleration of the head from an impulsive force that results in a change in mental status.[1]Centers for Disease Control and Prevention. What is a concussion? Feb 2019 [internet publication]. https://www.cdc.gov/headsup/basics/concussion_whatis.html The Glasgow Coma Scale (GCS) remains the main instrument for classifying the severity of TBI as mild (GCS 13-15), moderate (GCS 9-12), or severe (GCS ≤8).[2]Maas AIR, Menon DK, Manley GT, et al. Traumatic brain injury: progress and challenges in prevention, clinical care, and research. Lancet Neurol. 2022 Nov;21(11):1004-60. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10427240 http://www.ncbi.nlm.nih.gov/pubmed/36183712?tool=bestpractice.com ​ However, the GCS is confounded by several factors, including drug and alcohol use, medications, and tracheal intubation.[2]Maas AIR, Menon DK, Manley GT, et al. Traumatic brain injury: progress and challenges in prevention, clinical care, and research. Lancet Neurol. 2022 Nov;21(11):1004-60. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10427240 http://www.ncbi.nlm.nih.gov/pubmed/36183712?tool=bestpractice.com ​ Concussion is a subset of mild traumatic brain injury which is classified based on acute injury characteristics at the less severe end of the brain injury spectrum.[3]Harmon KG, Clugston JR, Dec K, et al. American Medical Society for Sports Medicine position statement on concussion in sport. Clin J Sport Med. 2019 Mar;29(2):87-100. https://journals.lww.com/cjsportsmed/fulltext/2019/03000/american_medical_society_for_sports_medicine.1.aspx http://www.ncbi.nlm.nih.gov/pubmed/30730386?tool=bestpractice.com ​ Currently there are no distinct symptom profiles, diagnostic criteria, or objective biomarkers that distinguish concussion from mild TBI.[4]Mayer AR, Quinn DK, Master CL. The spectrum of mild traumatic brain injury: A review. Neurology. 2017 Aug 8;89(6):623-32. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5562956 http://www.ncbi.nlm.nih.gov/pubmed/28701496?tool=bestpractice.com

This topic covers the acute management of mild traumatic brain injury in adults and children.