AMA Journal concludes that “the term mild TBI misrepresents the immediate and long-term burden of TBI”
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.”
Over the last 15 years , fueled in part with research funded by the US Military and the NFL, the science of MTBI has advanced. More advanced imaging, blood biomarkers, vision, hearing and balance testing, endocrine assessments, cognitive testing, and other advances have demonstrated that patients with lasting symptoms following MTBI typically show objective signs of brain damage – in other words their persistent symptoms are real and not imagined and often have an objective physiological basis. The good news is that this research has also led to interventions that can improve outcome, including such things as specially designed PT, OT, vision therapy, exercise therapy, endocrine therapy and counseling. This blog has described this research in posts over the last several years.
Despite all of this research, there has been a persistent viewpoint among a minority of medical experts that MTBI is benign and short-lived and that any persistent issues are either emotionally based or caused by unrelated physical problems. (Many of the clinicians who espouse this viewpoint are regularly retained by insurers seeking to defeat personal injury claims arising from MTBI).
The minority view that MTBI is essentially benign became further marginalized with the June 3, 2019 online publication of a significant cohert study by the AMA Journal Neurology.
The study concludes: “the term mild TBI misrepresents the immediate and long-term burden of TBI and other cooccurring factors experienced by this patient population.” The study followed 1453 patients presenting at level 1 trauma centers from February, 2014 to August 2018. Of this number, 1154 had signs of MTBI and 299 had peripheral orthopedic injury, but no signs of TBI (the later group served as the control.) One year outcomes were measured by neuropsychological measures, measures of daily functioning (the “GOSE” score) and symptoms measures. The study found that 53% of participants with MTBI were experiencing impairments at 12 months post-injury. Symptoms included headaches, fatigue, depression and forgetfulness. Patients with persistent symptoms also performed more poorly on cognitive tests than patients in the control group. Consistent with other studies, the worse outcomes were found in patients with “complicated” MBTIs, defined as patients who showed acute intercranial findings on imaging.
The importance of the study, the authors conclude, is that it highlights the need for improved treatment of MTBI, citing studies showing that early identification and treatment often improves outcomes. Perhaps it is time to adopt new terms to describe brain injury, terms less misleading than the term “mild.”