Diagnosis

Lt Col Reynolds
Diagnosis of a mild traumatic brain injury, or concussion, is based primarily on the classification criteria that determine the severity of the injury. These criteria include:

• Loss of consciousness
• Alteration of consciousness or mental state, and
• Post-traumatic amnesia, or loss of memory surrounding the event

Dr. Freeman, can you tell us how these criteria are used to diagnose mild TBI?

Dr. Freeman
Yes, I can, Dr. Reynolds. A person who has experienced trauma to the head will be diagnosed with mild TBI or concussion if any of the following are true:

• The trauma caused them to lose consciousness for up to 30 minutes
• The trauma didn’t cause them to lose consciousness, but did cause them to feel dazed and confused for up to 24 hours. This is also known as an alteration of consciousness, or
• They experience post-traumatic amnesia for less than 24 hours

It’s important to note that although the Glasgow Coma Scale, or GCS, is widely used in clinical practice to help classify the severity of TBI, the Department of Defense has recently recommended against using GCS scores for the purposes of diagnosing TBI. Because the GCS is so widely used, however, it’s useful to know what it is, and what score indicates a mild TBI.

The Glasgow Coma Scale measures a person’s ability to open their eyes, as well as their ability to respond to spoken questions and physical prompts for movements. A GCS score between 13 and 15 indicates concussion or mild TBI.

A provider may order imaging tests if they have reason to believe that other damage to the skull or brain has occurred. Even a diagnosis of mild TBI can turn into a serious problem if there are conditions that haven’t yet presented symptoms, such as a hematoma, or bleeding, in or around the brain.