Traumatic Brain Injury (TBI)
Bailey Frei
Background
- TBI is categorized as a disruption in brain function due to an external blow or force leading to decreased consciousness, memory deficits, neurological deficits, or intracranial lesion.
- Most common causes of TBI are falls and MVC.
- Falls are the most common cause of TBI in elderly population
Assessment
- Mechanism of injury
- Initial GCS
- Loss of consciousness and duration
- Other injuries
- Initial evaluation should include a non-contrasted head CT to rule out hemorrhage
- Full neuro exam including but not limited to cranial nerves, strength, cognition (orientation), memory, reflexes, sensation, cerebellar testing, range of motion of joints, Babinski, and Hoffmann's
Classification
Severity
|
GCS
|
Post-Traumatic Amnesia
|
Loss of Consciousness
|
| Mild |
13-15 |
<1 day |
<30 minutes |
| Moderate |
9-12 |
1 day to 7 days |
>30 minutes and <24 hours |
| Severe |
3-8 |
>1 week |
> 24 hours |
Evaluation and Management
- Acutely, pts are at risk for seizures, agitation, autonomic dysfunction, bowel or bladder dysfunction, wounds, vertigo, headaches, cognitive impairment, venous thrombosis, and spasticity.
- If concerned about TBI would consult PM&R and Speech Therapy for assistance in management of complications and assessment of cognition
- If concerned for spasticity refer to “Spasticity section” for medication recommendations
