As reflected in the posts on this blog over the last several years, scientific understanding of “mild traumatic brain injury” (Mtbi) – often referred to as “concussion” – has advanced considerably over the last 30 years. Unfortunately many physicians, including those on the “front lines” for these injuries–in emergency rooms and primary care clinics–have not kept up with this evolving science. In emergency rooms, the focus is typically on ruling out catastrophic injuries. The signs and symptoms of concussion are often missed. Even where the symptoms are recognized, many physicians mistakenly believe, based on outdated information, that the symptoms of mTBI can be ignored and that virtually everyone recovers spontaneously. Compounding this misinformation is inconsistency in the definitions found in the literature, in many cases depending on when the definition was adopted.
In 2019 – to address some of these problems – the mTBI Task Force of the American College of Rehabilitation Medicine (ACRM) Brain Injury Special Interest Group undertook an updating of the 1993 ACRM definition of mTBI – one of the most widely recognized definitions. This work included rapid evidence reviews, an expert survey (to rate the diagnostic importance of various clinical signs, symptoms, test findings, and contextual factors), public and stakeholder engagement, and a Delphi consensus process with an international, interdisciplinary panel of clinician-scientists. The working group included 17 ACRM mTBI Task Force members and an external interdisciplinary expert panel of 32 clinician-scientists from seven countries and various fields such as sports, civilian trauma, and military settings. The new criteria adopted by this group are based on syntheses of current research evidence and went through several rounds of revision until more than 90 per cent of the expert panel agreed with what they were proposing. Read More
In 2003 CDC sent a report to Congress on “mild” traumatic brain injuries. (MTBI, also sometimes called “concussion.”) The report cautioned that, contrary to past understanding, “mild” brain injuries can cause serious, permanent problems:
“In recent decades, public health and health care communities have become increasingly aware that the consequences of mild traumatic brain injury (MTBI) may not, in fact, be mild. Epidemiologic research has identified MTBI as a public health problem of large magnitude, while clinical research has provided evidence that these injuries can cause serious, lasting problems.”
Although prior studies of the association between mTBI and dementia have been mixed, this study, among the largest epidemiological studies to date, adds to the weight of evidence suggesting that even mild TBI is associated with an increased dementia diagnosis risk. Read More
Sony Pictures has made a movie about the devastating long term effects of concussion in professional football players, and the NFL’s efforts to cover this up. Will Smith stars as Nigerian doctor Bennet Omalu, the pathologist who first discovered the prevalence in players of a degenerative disease known as chronic traumatic encephalopathy (CTE). A trailer for the movie has just been released and can be seen here.
This movie promises to bring even greater public attention to the growing body of evidence, discussed in many past posts in this blog, demonstrating that concussion can in some cases trigger a chronic degenerative process with permanent consequences. Read More
The April, 2015 issue of The American Surgeonreports on a retrospective study of 395 patients admitted to the ER following concussions (MTBI, or mild traumatic brain injury). The patients had “normal” Glascow Coma scores of 15 and normal CT scans and therefore met discharge criteria. The study found that a surprisingly high percentage of these patients (27%) had persistent deficits after neurocognitive testing and benefitted from referral for ongoing therapy. The study is authored by Hartwell et. al. and entitled “You Cannot Go Home: Routine Concussion Evaluation is Not Enough.” Read More
On the evening of November 13, 2014 the U.S. House of Representatives passed S. 2539, the Traumatic Brain Injury Reauthorization Act of 2014, (TBIRA) sponsored by Senator Orrin Hatch (R-UT) and co-sponsored by Senator Bob Casey (D-PA). The next step is for the bill to be signed by President Obama.
With Republicans and Democrats bitterly divided on most public policy issues, it is encouraging to see them come together on how to approach what is now being recognized as a serious public health issue – traumatic brain injury. Read More
Good News for Future Players, Bad News for Past and Current Players Left to Seek Compensation on an Individual Basis
On July 29, 2014, the NCAA and representatives of college athletes announced an agreement to settle a concussion class action lawsuit that came on the heels of a similar lawsuit against the NFL. The settlement will need to be approved by the Court, a process that could take several months. It is anticipated that several former athletes experiencing the long-term effects of concussions suffered in college sports will object to the settlement, since it does not provide any direct compensation – unlike the proposed settlement in the NFL case. Players with concussion claims are left to pursue those claims on an individual basis. Read More
Several recent developments demonstrate increasing recognition of the serious potential consequences of concussion, and commitment to minimize those consequences through appropriate treatment of concussion:
Physicians have an ethical obligation to become knowledgeable about concussion.
On June 9, 2014 the American Academy of Neurology, the largest professional association of neurologists, released a position paper stating that doctors have an ethical obligationto educate and protect athletes from sports concussion and clear them to play only when the athlete is medically ready, standing firm against objections from players, athletes and coaches. The statement declares that sports concussion “is a major issue in the world of health care” and requires more attention from physicians. Read More