Mild Traumatic Brain Injury

Question 1

TBI results in _____ deaths, hospitalizations, and ED visits each year (US)

Answer 1

1.7 million

Question 2

____% of TBI are estimated to be ____TBI; remainder are _____or _____

Answer 2

• 75% are estimated to be mild TBI; remainder are moderate or severe

Question 3

highest rates of TBI are seen in

Answer 3

highest rates in children 0-4 yr, adolescents 15-19 yr, and elderly >65 yr

Question 4

Mild Traumatic Brain Injury
Clinical Features
• somatic

Answer 4

headache, sleep disturbance, N/V, blurred vision

Question 5

Mild Traumatic Brain Injury

cognitive dysfunction:

Answer 5

attentional impairment, reduced processing speed, drowsiness, amnesia

Question 6

Mild Traumatic Brain Injury

emotion and behaviour:

Answer 6

impulsivity, irritability, depression

Question 7

Mild Traumatic Brain Injury

severe concussion:

Answer 7

may precipitate seizure, bradycardia, hypotension, sluggish pupils

Question 8

Mild Traumatic Brain Injury

Etiology

Answer 8

• falls, MVC, struck by an object, assault, sports

Question 9

Mild Traumatic Brain Injury

Investigations

Answer 9

• neurological exam
• concussion recognition tool (see thinkfirst.ca)
• imaging – CT as per Canadian CT Head Rules, or MRI if worsening symptoms despite normal CT

Question 10

Mild Traumatic Brain Injury Treatment. when to hospitalize? any medications?

Answer 10

• hospitalization with normal CT (GCS <15, seizures, bleeding diathesis), or with abnormal CT
• pharmacological management of pain, depression, headache
• follow Return to Play guidelines

Question 11

Mild Traumatic Brain Injury

Prognosis

Answer 11

• most recover with minimal treatment

Question 12

Mild Traumatic Brain Injury, if repeated can cause:

Answer 12

■ athletes with previous concussion are at increased risk of cumulative brain injury
• repeat TBI can lead to life-threatening cerebral edema or permanent impairment

Question 13

CT Head is only required for patients with minor HI with any one of the following HIGH-risk factors

Answer 13

• GCS score <15 at 2 h after injury
• Suspected open or depressed skull
fracture
• Any sign of basal skull fracture
• Vomiting ≥2 episodes
• Age ≥65 yr

Question 14

HIGH-risk factors are for

Answer 14

neurological intervention

Question 15

CT Head is only required for patients with minor HI with any one of the following Medium-risk factors

Answer 15

-Amnesia before impact >30 min (i.e.
cannot recall events just before impact)
• Dangerous mechanism (pedestrian
struck by MVC, occupant ejected from
motor vehicle, fall from height >3 ft or five
stairs)

Question 16

Minor HI is defined as

Answer 16

witnessed loss
of consciousness, definite amnesia, or
witnessed disorientation in a patient with a
GCS score of 13-15.