The Term Traumatic in Mild Traumatic Brain Injury and the Misrepresentation of Outcomes

To the Editor Nelson et al state that the term mild in mild traumatic brain injury misrepresents the burden of traumatic brain injury. Seminal prospective controlled studies by 3 of Nelson ’s own coauthors, who are neuropsychologists, that date back to the 1980s contradict the findings of this article. To my knowledge, Levin et al were the first to conclusively show that a single uncomplicated mild head injury produces no permanent neurobehavioral impairment. A Glasgow Coma Scale sc ore of 13 to 15 and a coma not to exceed 20 minutes was introduced earlier as a definition of mild head injury. Levin et al added normal imaging as the third defining feature to separate those with complicated mild head injury, namely acute imaging abnormalities. An earlier study that included patie nts with mild complicated injury showed cognitive and functional impairment. Dikmen et al published the second important article. One year post–head injury, patients who took up to an hour to follow commands did not differ cognitively from the controls. Curiously, neither of these 2 articles are c ited by Nelson et al. The benign outcome of mild head injury seen in the civilian literature was established by McCrea et al in the best-characterized sports concussion sample published at that time. The cognitive effects of concussion resolve in 7 days.
Source: JAMA Neurology - Category: Neurology Source Type: research