Mild traumatic brain injury. An underestimated trauma?

Background. Each year an estimated 250,000 cases of mild traumatic brain injury (mTBI) occur in Germany. A TBI is defined as a result of mechanical energy to the head from external physical forces leading to malfunction and/or injury of the brain with a Glasgow Coma Scale value from 13 to 15. Objective. The definition, treatment modalities and prognosis of mTBI are presented. Material and methods. An analysis of the state of the science according to personal experience and a literature search was carried out. Results. In the initial phase mTBI can be a dynamic disorder which is why hospital admission for continuous surveillance is advocated. Treatment consists of avoidance of external stimuli by shielding and resting. There should be neither physical nor mental activities as long as symptoms persist. Ongoing symptoms have to result in comprehensive diagnostics. Most of the patients return to work within 3-6 months but persisting problems are also possible, leading to the so-called postconcussional syndrome (PCS) showing nonspecific symptoms, such as headache, dizziness, cognitive dysfunction and irritability. Risk factors for PCS can be a lower level of education, dizziness and vomiting in the acute phase. Conclusion. The mTBI is an underestimated entity. Chronic symptoms may develop that persist for years and prevent a return to work. That is why we propose screening of all patients with mTBI after 3 months using a simple standardized mail questionnaire. Each conspicuous result should lead to extensive diagnostics within the brain check program provided by the German workers compensation hospitals.