A recent article in Neurology (Menon, 2017) focused on male hockey players between the ages of 11 and 14 years diagnosed with concussion. This article concluded that MRI changes, along with clinical deficits in thinking, memory and balance persisted well after the patients’ clinical scores returned to normal and they had been cleared to play. In addition, “ongoing white matter maturation may make adolescent athletes particularly vulnerable to brain injury, and they may require extended recovery periods.”
Traumatic brain injury (TBI) is a public health concern with 2.5 – 3.8 million cases per year seen in the United States alone. Of these, 79-90% are labeled as mild TBI or concussion. A recent poll by National Public Radio reported that 25% of Americans report having suffered a concussion at some point in their lives with many (by one report at least 88% of cases) not seeking medical attention.
A second recent article in Frontiers in Neurology (Kenzie, 2017) calls concussion or mild TBI “the most complicated disease of the most complex organ of the body”. The article cites the lack of reliable criteria for diagnosis and prognosis, noting that every clinical trial to date has failed to show reliable and safe improvement in outcomes. The authors also note the existing body of literature is insufficient to support the creation of a new classification system. Research is impeded by imprecision in classification, methodological inconsistencies, measurement issues, and uncertainty about underlying pathophysiology.
Kenzie, et al., define concussion as a highly heterogeneous phenomenon, where numerous factors interact dynamically to influence an individual’s recovery trajectory. Over 30 clinical trials of pharmaceutical products to treat TBI have failed and the U.S. Food and Drug Administration has yet to approve a single diagnostic test or therapy for the condition.
While this complex and ongoing research into concussion continues it is interesting to note that the AIS (Abbreviated Injury Scale) 2005 update 2008, lists two codes for concussion:
161000.1 – Cerebral Concussion, NFS (not further specified) AND
161001.1 – mild concussion; no loss of consciousness
The following note pertains to use of the two codes above:
“Use 161000.1 and 161001.1 where there is a convincing evidence of head injury and where the medical diagnosis is given as “concussion” with no other description or clarification.”
The AAAM (Association for the Advancement of Automotive Medicine) has listed concussion as a minor injury. Classification stratification discussed above may lead to changes in how this injury is viewed and scored.
Susan Schmunk, CSTR, CAISS