Mild traumatic brain injury

World Health Organization diagnostic criteria[1]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, 30 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 neurologic 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 concussion.[75]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. Concussions are classified as minor. HISS is premised on the GCS but 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 14-15, amnesia, or short loss of consciousness, or impaired alertness/memory)

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

• Severe head injury (GCS score 5-8)

• Critical head injury (GCS score 3-4)

Sport Concussion Assessment Tool (SCAT)

A brief diagnostic tool used to assess the symptoms of concussion and their severity, as well as aid the monitoring of recovery. SCAT6: sport concussion assessment tool - 6th edition Opens in new window Cognitively, it assesses basic orientation, and includes brief memory and working memory tasks. Physiologically, it includes an assessment of gait and postural stability.

Other sideline evaluation tools include the McGill Abbreviated Concussion Evaluation (ACE), 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 computerized concussion management tool; ImPACT pediatric computerized concussion management tool).[72]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

Regardless of the choice of evaluation tool, an assessment of balance and postural stability is essential in the initial evaluation of the concussed athlete.