. 2023 Aug;104(8):1343-1355.

doi: 10.1016/j.apmr.2023.03.036. Epub 2023 May 19.

The American Congress of Rehabilitation Medicine Diagnostic Criteria for Mild Traumatic Brain Injury

Noah D Silverberg¹, Grant L Iverson²; ACRM Brain Injury Special Interest Group Mild TBI Task Force members:; Alison Cogan³, Kristen Dams-O-Connor⁴, Richard Delmonico⁵, Min Jeong P Graf⁶, Mary Alexis Iaccarino⁷, Maria Kajankova⁴, Joshua Kamins⁸, Karen L McCulloch⁹, Gary McKinney¹⁰, Drew Nagele¹¹, William J Panenka¹², Amanda R Rabinowitz¹³, Nick Reed¹⁴, Jennifer V Wethe¹⁵, Victoria Whitehair¹⁶; ACRM Mild TBI Diagnostic Criteria Expert Consensus Group:; Vicki Anderson¹⁷, David B Arciniegas¹⁸, Mark T Bayley¹⁹, Jeffery J Bazarian²⁰, Kathleen R Bell²¹, Steven P Broglio²², David Cifu²³, Gavin A Davis²⁴, Jiri Dvorak²⁵, Ruben J Echemendia²⁶, Gerard A Gioia²⁷, Christopher C Giza²⁸, Sidney R Hinds 2nd²⁹, Douglas I Katz³⁰, Brad G Kurowski³¹, John J Leddy³², Natalie Le Sage³³, Angela Lumba-Brown³⁴, Andrew Ir Maas³⁵, Geoffrey T Manley³⁶, Michael McCrea³⁷, David K Menon³⁸, Jennie Ponsford³⁹, Margot Putukian⁴⁰, Stacy J Suskauer⁴¹, Joukje van der Naalt⁴², William C Walker⁴³, Keith Owen Yeates⁴⁴, Ross Zafonte⁴⁵, Nathan D Zasler⁴⁶, Roger Zemek⁴⁷

Affiliations

¹ Department of Psychology, University of British Columbia, Vancouver, Canada; Vancouver Coastal Health Research Institute, Vancouver, Canada; Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada. Electronic address: noah.silverberg@ubc.ca.
² Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Sports Concussion Program, MassGeneral Hospital for Children, Boston, MA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA; Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA; Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA.
³ Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, CA.
⁴ Department of Rehabilitation and Human Performance, Brain Injury Research Center of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY.
⁵ Kaiser Foundation Rehabilitation Center, The Permanente Medical Group, Vallejo, CA.
⁶ Department of Physical Medicine and Rehabilitation, Hennepin Healthcare, Minneapolis, MN; Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN.
⁷ Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, CA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA; Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA.
⁸ UCLA Steve Tisch BrainSPORT Program, David Geffen School of Medicine at UCLA, Los Angeles, CA.
⁹ Division of Physical Therapy, Department of Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
¹⁰ Traumatic Brain Injury Center of Excellence, Defense Health Agency, Silver Spring, MD.
¹¹ School of Professional and Applied Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, PA.
¹² Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
¹³ Moss Rehabilitation Research Institute, Elkins Park, PA.
¹⁴ Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada.
¹⁵ Mayo Clinic School of Medicine, Scottsdale, AZ.
¹⁶ MetroHealth Rehabilitation Institute and Case Western Reserve University, Cleveland, OH.
¹⁷ Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Australia.
¹⁸ University of New Mexico School of Medicine, University of Colorado School of Medicine, Aurora, CO.
¹⁹ Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Canada.
²⁰ University of Rochester School of Medicine and Dentistry, Rochester, NY.
²¹ University of Texas Southwestern Medical Center, Dallas, TX.
²² University of Michigan, Michigan Concussion Center, Ann Arbor, MI.
²³ Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, VA; U.S. Department of Veterans Affairs, Richmond, VA.
²⁴ Cabrini Health, Cabrini Malvern, Melbourne, Australia.
²⁵ Schulthess Klinic, Zurich, Switzerland; Swiss Concussion Center, Zurich, Switzerland.
²⁶ University Orthopedics Center, Concussion Care Clinic, University of Missouri-Kansas City, Kansas City, MO.
²⁷ Division of Neuropsychology/SCORE Concussion Program, Children's National Hospital, George Washington University School of Medicine, Rockville, MD.
²⁸ University of California at Los Angeles, Departments of Neurosurgery and Pediatrics, Steve Tisch BrainSPORT Program, Los Angeles, CA.
²⁹ Uniformed Services University, Department of Neurology and Radiology, Bethesda, MD.
³⁰ Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, MA.
³¹ Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Departments of Pediatrics, Neurology, and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH.
³² UBMD Department of Orthopaedics and Sports Medicine, SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY.
³³ Population Health and Optimal Health Practices Axis, CHU de Québec-Université Laval Research Centre, VITAM-Centre de recherche en santé durable, Québec, Canada; Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada.
³⁴ Department of Emergency Medicine, Stanford University, Stanford, CA.
³⁵ Antwerp University Hospital, Edegem, Belgium; University of Antwerp, Edegem, Belgium.
³⁶ Department of Neurosurgery, University of California, San Francisco, CA.
³⁷ Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI.
³⁸ University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom.
³⁹ Monash University, Clayton, Australia.
⁴⁰ Major League Soccer; Princeton, NJ.
⁴¹ Kennedy Krieger Institute and Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD.
⁴² Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
⁴³ Virginia Commonwealth University, Richmond, VA.
⁴⁴ Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
⁴⁵ Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA; Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Boston, MA.
⁴⁶ Concussion Care Centre of Virginia, Henrico, VA.
⁴⁷ Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario, Ottawa, Canada.

PMID: 37211140
DOI: 10.1016/j.apmr.2023.03.036

The American Congress of Rehabilitation Medicine Diagnostic Criteria for Mild Traumatic Brain Injury

Noah D Silverberg et al. Arch Phys Med Rehabil. 2023 Aug.

. 2023 Aug;104(8):1343-1355.

doi: 10.1016/j.apmr.2023.03.036. Epub 2023 May 19.

Authors

Affiliations

¹ Department of Psychology, University of British Columbia, Vancouver, Canada; Vancouver Coastal Health Research Institute, Vancouver, Canada; Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada. Electronic address: noah.silverberg@ubc.ca.
² Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Sports Concussion Program, MassGeneral Hospital for Children, Boston, MA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA; Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA; Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA.
³ Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, CA.
⁴ Department of Rehabilitation and Human Performance, Brain Injury Research Center of Mount Sinai, Icahn School of Medicine at Mount Sinai, New York, NY.
⁵ Kaiser Foundation Rehabilitation Center, The Permanente Medical Group, Vallejo, CA.
⁶ Department of Physical Medicine and Rehabilitation, Hennepin Healthcare, Minneapolis, MN; Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN.
⁷ Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, CA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA; Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA.
⁸ UCLA Steve Tisch BrainSPORT Program, David Geffen School of Medicine at UCLA, Los Angeles, CA.
⁹ Division of Physical Therapy, Department of Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
¹⁰ Traumatic Brain Injury Center of Excellence, Defense Health Agency, Silver Spring, MD.
¹¹ School of Professional and Applied Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, PA.
¹² Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
¹³ Moss Rehabilitation Research Institute, Elkins Park, PA.
¹⁴ Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada.
¹⁵ Mayo Clinic School of Medicine, Scottsdale, AZ.
¹⁶ MetroHealth Rehabilitation Institute and Case Western Reserve University, Cleveland, OH.
¹⁷ Murdoch Children's Research Institute, The Royal Children's Hospital, Parkville, Australia.
¹⁸ University of New Mexico School of Medicine, University of Colorado School of Medicine, Aurora, CO.
¹⁹ Toronto Rehabilitation Institute, University Health Network, University of Toronto, Toronto, Canada.
²⁰ University of Rochester School of Medicine and Dentistry, Rochester, NY.
²¹ University of Texas Southwestern Medical Center, Dallas, TX.
²² University of Michigan, Michigan Concussion Center, Ann Arbor, MI.
²³ Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, VA; U.S. Department of Veterans Affairs, Richmond, VA.
²⁴ Cabrini Health, Cabrini Malvern, Melbourne, Australia.
²⁵ Schulthess Klinic, Zurich, Switzerland; Swiss Concussion Center, Zurich, Switzerland.
²⁶ University Orthopedics Center, Concussion Care Clinic, University of Missouri-Kansas City, Kansas City, MO.
²⁷ Division of Neuropsychology/SCORE Concussion Program, Children's National Hospital, George Washington University School of Medicine, Rockville, MD.
²⁸ University of California at Los Angeles, Departments of Neurosurgery and Pediatrics, Steve Tisch BrainSPORT Program, Los Angeles, CA.
²⁹ Uniformed Services University, Department of Neurology and Radiology, Bethesda, MD.
³⁰ Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, MA.
³¹ Division of Pediatric Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Departments of Pediatrics, Neurology, and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH.
³² UBMD Department of Orthopaedics and Sports Medicine, SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY.
³³ Population Health and Optimal Health Practices Axis, CHU de Québec-Université Laval Research Centre, VITAM-Centre de recherche en santé durable, Québec, Canada; Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada.
³⁴ Department of Emergency Medicine, Stanford University, Stanford, CA.
³⁵ Antwerp University Hospital, Edegem, Belgium; University of Antwerp, Edegem, Belgium.
³⁶ Department of Neurosurgery, University of California, San Francisco, CA.
³⁷ Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI.
³⁸ University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom.
³⁹ Monash University, Clayton, Australia.
⁴⁰ Major League Soccer; Princeton, NJ.
⁴¹ Kennedy Krieger Institute and Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD.
⁴² Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
⁴³ Virginia Commonwealth University, Richmond, VA.
⁴⁴ Department of Psychology, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
⁴⁵ Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA; Department of Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA; Department of Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Boston, MA.
⁴⁶ Concussion Care Centre of Virginia, Henrico, VA.
⁴⁷ Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario, Ottawa, Canada.

PMID: 37211140
DOI: 10.1016/j.apmr.2023.03.036

Abstract

Objective: To develop new diagnostic criteria for mild traumatic brain injury (TBI) that are appropriate for use across the lifespan and in sports, civilian trauma, and military settings.

Design: Rapid evidence reviews on 12 clinical questions and Delphi method for expert consensus.

Participants: The Mild Traumatic Brain Injury Task Force of the American Congress of Rehabilitation Medicine Brain Injury Special Interest Group convened a Working Group of 17 members and an external interdisciplinary expert panel of 32 clinician-scientists. Public stakeholder feedback was analyzed from 68 individuals and 23 organizations.

Results: The first 2 Delphi votes asked the expert panel to rate their agreement with both the diagnostic criteria for mild TBI and the supporting evidence statements. In the first round, 10 of 12 evidence statements reached consensus agreement. Revised evidence statements underwent a second round of expert panel voting, where consensus was achieved for all. For the diagnostic criteria, the final agreement rate, after the third vote, was 90.7%. Public stakeholder feedback was incorporated into the diagnostic criteria revision prior to the third expert panel vote. A terminology question was added to the third round of Delphi voting, where 30 of 32 (93.8%) expert panel members agreed that 'the diagnostic label 'concussion' may be used interchangeably with 'mild TBI' when neuroimaging is normal or not clinically indicated.'

Conclusions: New diagnostic criteria for mild TBI were developed through an evidence review and expert consensus process. Having unified diagnostic criteria for mild TBI can improve the quality and consistency of mild TBI research and clinical care.

Keywords: Brain injury; Concussion; Consensus; Craniocerebral trauma; Diagnostic; Occupational therapy; Rehabilitation.

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The American Congress of Rehabilitation Medicine Diagnostic Criteria for Mild Traumatic Brain Injury

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The American Congress of Rehabilitation Medicine Diagnostic Criteria for Mild Traumatic Brain Injury

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