Preventing Mild Traumatic Brain Injury: the CDC Presents Data

The silent epidemic, Traumatic Brain Injury (TBI), creeps up on people because the problems that arise from TBI are sometimes unrecognizable. The mild version, Mild Traumatic Brain Injury (MTBI), gets even less attention despite its high percentage (75%) for all traumatic brain injuries in the U.S. The CDC has become involved, reporting its findings since it is clear that the consequences of MTBI can be severe and cause life-long disability and deficits.

The CDC's report went to Congress and recommended steps to help with this serious public health issue–which I personally support completely as a San Francisco Brain Injury Attorney who would sincerely love to see the survivors of head injuries get the diagnosis and the help that they truly deserve.

An MTBI Work Group comprised of experts in the field of brain injury, was formed by the CDC hoping to narrow down and determine appropriate and feasible methods for assessing the incidence and prevalence of MTBI in the U.S. This group also pointed out how to better measure the magnitude of the problem. Congress had enacted the Children's Health Act of 2000 (Public Law 106-310), whereby data was to be obtained on the incidence and prevalence of MTBI, to which the CDC responded.

MTBI is an injury to the head as a result of a blunt trauma. The conceptual definition of MTBI goes on to define its result by one or more of the following conditions:

• any period of loss of consciousness
• any loss of memory for events immediately before of after the accident
• any alteration in mental state at the time of the accident (e.g., feeling dazed, disoriented, or confused)
• focal neurological deficit(s) that may or may not be transient; but where the severity of the injury does not exceed the following:
  • post-traumatic amnesia (PTA) not greater than 24 hours
  • after 30 minutes, an initial Glasgow Coma Scale (GCS) of 13-15
  • loss of consciousness of approximately 30 minutes or less.

MTBI sufferers often do not have temporary impairments, but can also have potential permanent disabilities. It is not uncommon to be held up from returning to normal routines for weeks or months, sometimes forever. Many cases of MTBI are not treated at all because of poorly trained clinicians, because of the mainstream notion that hospitalized head injuries are only victims of under reporting.

We need development of better systems to more accurately and definitively detect brain injuries. Regardless of serious or mild traumatic brain injury, all head injured people deserve to be properly worked up, insured and uninsured alike, including those in national hospitals and high school and collegiate sports.

It is high time that the public be made aware of the prevalence of undiagnosed TBI and MTBI, in the hope that those whose lives have been altered are given another chance.

Historically, clinicians and investigators have classified traumatic brain injury as mild, moderate, and severe by using the scores of the Glasgow Coma Scale, a widely-used scoring system to assess coma and impaired consciousness.

MTBI is otherwise known as concussion, minor head injury, minor brain injury or minor head trauma, and is one of the most common neurologic disorders. Although a variety of radiological and laboratory techniques have been used to diagnose TBI (i.e., X-rays of the skull, computed tomography of the brain, MRI, and SPECT), these studies generally only help to rule out more serious TBIs. These tests are often not sensitive enough in detecting MTBI–many not presenting imaging abnormalities.

I would like to see additional research undertaken into better more advanced techniques to accurately diagnose MTBI. The MTBI Work Group's findings are startling. People with MTBI and their health care providers should be better informed as to the reality of the true injuries faced by sustaining even brief periods of unconsciousness or memory loss caused by a blow to the head. I'd like to see individuals with MTBI receive adequate medical care at the time of the injury so that they are less fearful and confused later when presented with persistent symptoms. Early diagnosis is also critical to prevention of further injury.

Perhaps one of the reasons MTBI is not taken as seriously as it should be is a vague definition of the condition? I am happy to learn that this study recommended an official definiton to Congress. All health care providers need to be better trained to recognize the potential impact of MTBI–and not just the ER doctors or neurologists.

About the author: Claude Wyle is an aggressive advocate for San Francisco Bay Area head trauma victims. Claude has decades of experience representing those harmed by the wrongful conduct of others, and, as a San Francisco brain injury lawyer, has fought to protect the rights of head injury survivors throughout his legal career.