Mild traumatic brain injury

World Health Organization diagnostic criteria[18]Holm L, Cassidy JD, Carroll LJ, et al. Summary of the WHO Collaborating Centre for Neurotrauma Task Force on mild traumatic brain injury. J Rehabil Med. 2005 May;37(3):137-41. http://www.ncbi.nlm.nih.gov/pubmed/16040469?tool=bestpractice.com

The criteria for identifying mild traumatic brain injury (TBI) include a Glasgow Coma Scale (GCS) score of 13 to 15, thirty minutes or later post-injury, and ≥1 of the following:

• Confusion or disorientation

• Loss of consciousness for ≤30 minutes

• Post-traumatic amnesia for <24 hours

• Other transient neurological abnormalities (e.g., seizure, focal signs, intracranial lesion not requiring surgery).

Head Injury Severity Scale (HISS)

Used to distinguish between different severities of TBI. Must be followed by a thorough history and assessment of symptoms to confirm the diagnosis of a mild TBI.[69]Stein SC, Spettell C. The head injury severity scale (HISS): a practical classification of closed-head injury. Brain Inj. 1995 Jul;9(5):437-44. http://www.ncbi.nlm.nih.gov/pubmed/7550215?tool=bestpractice.com Assesses degree of head injury severity. The HISS is based on the GCS but also includes recommendations based on the presence or absence of complicating factors. Head injury is divided into 5 severities:

• Minimal head injury (GCS score 15, no loss of consciousness or amnesia)

• Mild head injury (GCS score 14 to 15, amnesia, or short loss of consciousness, or impaired alertness/memory)

• Moderate head injury (GCS score 9 to 13, loss of consciousness >5 minutes or focal neurological deficit)

• Severe head injury (GCS score 5 to 8)

• Critical head injury (GCS score 3 to 4).

Sport Concussion Assessment Tool (SCAT)

A brief diagnostic tool used to assess the symptoms of mild TBI (concussion) and their severity, as well as aid the monitoring of recovery. SCAT6: sport concussion assessment tool - 6th edition Opens in new window Child-SCAT6: sport concussion assessment tool for children ages 5 to 12 years Opens in new window Cognitively, it assesses basic orientation questions, and provides brief memory and working memory tasks. Physiologically, it includes a brief assessment of gait and postural stability.

The SCAT is one example of a sideline evaluation tool. Others include the McGill Abbreviated Concussion Evaluation (ACE),[70]Johnston KM, Lassonde M, Ptito A. A contemporary neurosurgical approach to sport-related head injury: the McGill concussion protocol. J Am Coll Surg. 2001 Apr;192(4):515-24. http://www.ncbi.nlm.nih.gov/pubmed/11294409?tool=bestpractice.com and the various iterations of the ImPACT cognitive test for the assessment of signs and symptoms of head injury (i.e., ImPACT sideline card; ImPACT computerised concussion management tool; ImPACT paediatric computerised concussion management tool).