The CDC has revised its mild traumatic brain injury tool kit.
Mild traumatic brain injury (MTBI) accounts for 75% to 90% of traumatic brain injury cases, and duration of symptoms usually ranges from minutes to months. Research has expanded our knowledge and increased our awareness of the extent, incidence, and long‐term effects of MTBI, with or without loss of consciousness (LOC).
Most physicians who care for pediatric patients occasionally are called on to treat patients with trauma. To help clinicians manage patients with MTBI, the CDC has revised its “Heads Up: Brain Injury in Your Practice” tool kit. The tool kit includes a booklet on diagnosis and management of MTBI, a patient evaluation tool, an information sheet for patients to help guide their recovery, a palm card for on‐field management of sports‐related MTBI, and patient education materials.
The booklet reminds clinicians that patients with MTBI do not necessarily lose consciousness and typically have normal structural neuroimaging studies. Symptoms, which result more from dysfunction of brain metabolism than from structural damage, generally fall into four categories: physical, cognitive, emotional, and sleep‐related. Monitoring symptoms, which might persist for weeks or months and might worsen with activity, is stressed. Clear guidelines also are provided for referral to specialized care. The section on prevention, which outlines strategies to minimize risk for MTBI, is equally important.
Physicians can systematically evaluate patients with obvious or suspected concussion by using the three‐part Acute Concussion Evaluation form (injury characteristics, symptoms, and risk factors for protracted recovery). For sports team physicians, the palm card is helpful in evaluating and managing sports‐related injuries.
This is one of the most valuable tool kits I have seen; it does an excellent job of defining MTBI and describing how best to manage MTBI. I am now more aware that LOC is not a requirement for diagnosis of MTBI and that symptoms can be relatively subtle, persist for weeks, and include sleep disturbances. I urge every primary care physician to obtain and use this tool kit to assist them in management of children with MTBI.
William P. Kanto, Jr., MD
Published in Journal Watch Pediatrics and Adolescent Medicine August 29, 2007