Concussion

Although there is no consensus on the definition of a concussion, the committee on head injury nomenclature of the Congress of Neurological Surgeons long ago defined concussion as follows:

More recently, the term traumatic brain injury (TBI) has gained popularity, as it more accurately describes the condition. TBI can range from mild, with only brief changes in function, or severe, with prolonged alteration in function and long-term complications.

The number of people who suffer from TBI each year is unknown. The Centers for Disease Control and Prevention state that 1.4 million people in 2004 presented to emergency departments for TBI. Other studies have estimated the incidence of TBI in high school football alone as 250,000 cases annually and that up to 20 percent of players sustain a concussion. Leading causes of TBI are sporting activities, falls, motor vehicle collisions, being struck by or against an object, and assaults. Males are one and a half times as likely as females to suffer TBI; two distinct age groups are more likely to suffer TBI: 0–4 year olds and 15–19 year olds.

It is advisable to safeguard against TBI by ensuring athletes wear proper head protection during any competition or training when TBI could occur. Drivers and passengers in motor vehicles should wear seat belts at all times. Homes should be made as fall proof as possible, and to lessen the risk of TBI to infants and children, countertops and furniture edges should be padded and stairways should be blocked.

Immediate signs and symptoms of TBI are confusion, amnesia, headache, ringing in the ears, drowsiness, nausea, vomiting, unequal pupil size, convulsions, unusual eye movements, slurred speech, and loss of consciousness. Later, the sufferer may develop poor concentration, irritability, sleep disturbances, personality changes, and fatigue.

Management of someone who has sustained a TBI is another area of debate because of the lack of evi-dence-based data on assessment and outcomes. There have been multiple different guidelines published for the evaluation and management of TBI. It is uniformly accepted that any loss of consciousness warrants transportation to a hospital for further evaluation. If the loss of consciousness is prolonged, the addition of cervical spine precautions and stabilization is warranted, and neuroimaging should be performed at the hospital. If the TBI is thought to be mild, and the sufferer is not immediately evaluated in an emergency department, family members should still be educated on monitoring for delayed symptoms that may need to be evaluated if they occur.

Hospital evaluation should include a detailed neurological examination with mental status evaluation. Examination should seek evidence of associated trauma or injuries such as cuts, bruising, or possibly broken bones. Neuroimaging may be performed [Page 439]and includes computerized tomography (CT) scan or magnetic resonance imaging (MRI) scan. The CT scan is the best way to evaluate a serious head injury, as it can accurately diagnose bleeding under the skull or within the brain itself, as well as fractures of the skull bones.

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