Traumatic alterations in consciousness: traumatic brain injury

Abstract

Mild traumatic brain injury (mTBI) refers to the clinical condition of transient alteration of consciousness as a result of traumatic injury to the brain. The priority of emergency care is to identify and facilitate the treatment of rare but potentially life-threatening intracranial injuries associated with mTBI through the judicious application of appropriate imaging studies and neurosurgical consultation. Although post-mTBI symptoms quickly and completely resolve in the vast majority of cases, a significant number of patients will complain of lasting problems that may cause significant disability. Simple and early interventions such as patient education and appropriate referral can reduce the likelihood of chronic symptoms. Although definitive evidence is lacking, mTBI is likely to be related to significant long-term sequelae such as Alzheimer disease and other neurodegenerative processes.

Figure 1. Indications for Obtaining Non-contrast Head CT after TBI

Non-contrast head CT is the study of choice to evaluate TBI patients for clinically important neurotrauma. Clinically important neurotrauma is defined as any traumatically induced intracranial injury that requires neurosurgical intervention or requires hospital admission and neurosurgical follow-up. Clinically important TBI occurs rarely after mTBI, therefore minimizing unnecessary head CT scans is desirable. This figure integrates validated decision rules for both adult and pediatric patients designed to minimize unnecessary CT scans after mTBI.