Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-848d4c4894-mwx4w Total loading time: 0 Render date: 2024-07-01T00:53:37.644Z Has data issue: false hasContentIssue false

Chapter 7 - Early Phase Care of Patients with Mild and Minor Head Injury

Published online by Cambridge University Press:  28 April 2020

By
Anthony Kehoe
Edited by
Peter C. Whitfield ,
Jessie Welbourne ,
Elfyn Thomas ,
Fiona Summers ,
Maggie Whyte  and
Peter J. Hutchinson
Peter C. Whitfield
Affiliation:
Derriford Hospital, Plymouth
Jessie Welbourne
Affiliation:
University Hospitals, Plymouth
Elfyn Thomas
Affiliation:
Derriford Hospital, Plymouth
Fiona Summers
Affiliation:
Aberdeen Royal Infirmary
Maggie Whyte
Affiliation:
Aberdeen Royal Infirmary
Peter J. Hutchinson
Affiliation:
Addenbrooke’s Hospital, Cambridge
Get access

Summary

Mild traumatic brain injury (mTBI) is a common presentation to the Emergency Department (ED). In most cases patients can be assessed and discharged the same day with reassurance that within a short period any residual symptoms will resolve. However, for a sizeable minority of patients diagnosed with mTBI, the term can seem a cruel misnomer. Many will suffer with a constellation of debilitating symptoms including fatigue, irritability, lability of mood, inability to concentrate, headache, dizziness, sensitivity to noise and light, depression and anxiety.1 Although in most, these symptoms will subside within 3 months; in up to 30% of patients with mTBI, they can persist well beyond 6 months.2 The consequences for quality of life, relationships and employment can be devastating.

Type
Chapter
Information
Traumatic Brain Injury
A Multidisciplinary Approach
 , pp. 65 - 75
Publisher: Cambridge University Press
Print publication year: 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Hou, R, Moss-Morris, R, Peveler, R, Mogg, K, Bradley, BP, Belli, A. When a minor head injury results in enduring symptoms: a prospective investigation of risk factors for postconcussional syndrome after mild traumatic brain injury. J Neurol Neurosurg Psychiatry 2012;83(2):217–23.Google Scholar
Stulemeijer, M, van der Werf, S, Borm, GF, Vos, PE. Early prediction of favourable recovery 6 months after mild traumatic brain injury. J Neurol Neurosurg Psychiatry 2008;79(8):936–42.CrossRefGoogle ScholarPubMed
Loane, DJ, Stoica, BA, Faden, AI. Neuroprotection for traumatic brain injury. Handb Clin Neurol 2015;127:343–66.CrossRefGoogle ScholarPubMed
Khong, E, Odenwald, N, Hashim, E, Cusimano, MD. Diffusion tensor imaging findings in post-concussion syndrome patients after mild traumatic brain injury: a systematic review. Front Neurol 2016;7:156.CrossRefGoogle ScholarPubMed
Kulbe, JR, Geddes, JW. Current status of fluid biomarkers in mild traumatic brain injury. Exp Neurol 2016;275(Pt 3):334–52.CrossRefGoogle ScholarPubMed
Malec, JF, Brown, AW, Leibson, CL, Flaada, JT, Mandrekar, JN, Diehl, NN, Perkins, PK. The mayo classification system for traumatic brain injury severity. J Neurotrauma 2007;24(9):1417–24.CrossRefGoogle ScholarPubMed
Kay, A, Teasdale, G. Head injury in the United Kingdom. World J Surg 2001;25(9):1210–20.CrossRefGoogle ScholarPubMed
Hodgkinson, S, Pollit, V, Sharpin, C, Lecky, F. National Institute for H, Care Excellence Guideline Development G: early management of head injury: summary of updated NICE guidance. BMJ 2014;348:g104.Google Scholar
Majdan, M, Plancikova, D, Brazinova, A, Rusnak, M, Nieboer, D, Feigin, V, Maas, A. Epidemiology of traumatic brain injuries in Europe: a cross-sectional analysis. Lancet Public Health 2016;1(2):e76–83.Google Scholar
Kanakaris, NK, Giannoudis, PV. Trauma networks: present and future challenges. BMC Med 2011;9(121):1–10.Google Scholar
Kehoe, A, Smith, JE, Edwards, A, Yates, D, Lecky, F. The changing face of major trauma in the UK. Emerg Med J 2015;32(12):911–15.CrossRefGoogle ScholarPubMed
Trauma Audit Research Network. Major trauma in older people. Press release (2017).Google Scholar
Kehoe, A, Smith, JE, Bouamra, O, Edwards, A, Yates, D, Lecky, F. Older patients with traumatic brain injury present with a higher GCS score than younger patients for a given severity of injury. Emerg Med J 2016;33(6):381–5.CrossRefGoogle ScholarPubMed
Trefan, L, Houston, R, Pearson, G, Edwards, R, Hyde, P, Maconochie, I, Parslow, RC, Kemp, A. Epidemiology of children with head injury: a national overview. Arch Dis Child 2016;101(6):527–32.Google Scholar
Fehily, B, Fitzgerald, M. Repeated mild traumatic brain injury: potential mechanisms of damage. Cell Transplant 2017;26(7):1131–55.CrossRefGoogle ScholarPubMed
Lozano, D, Gonzales-Portillo, GS, Acosta, S, de la Pena, I, Tajiri, N, Kaneko, Y, Borlongan, CV. Neuroinflammatory responses to traumatic brain injury: etiology, clinical consequences, and therapeutic opportunities. Neuropsychiatr Dis Treat 2015;11:97–106.Google Scholar
Perez-Polo, JR, Rea, HC, Johnson, KM, Parsley, MA, Unabia, GC, Xu, G, Infante, SK, Dewitt, DS, Hulsebosch, CE. Inflammatory consequences in a rodent model of mild traumatic brain injury. J Neurotrauma 2013;30(9):727–40.Google Scholar
Juratli, TA, Zang, B, Litz, RJ, Sitoci, KH, Aschenbrenner, U, Gottschlich, B, Daubner, D, Schackert, G, Sobottka, SB. Early hemorrhagic progression of traumatic brain contusions: frequency, correlation with coagulation disorders, and patient outcome: a prospective study. J Neurotrauma 2014;31(17):1521–7.CrossRefGoogle ScholarPubMed
Flygt, J, Djupsjo, A, Lenne, F, Marklund, N. Myelin loss and oligodendrocyte pathology in white matter tracts following traumatic brain injury in the rat. Eur J Neurosci 2013;38(1):2153–65.CrossRefGoogle ScholarPubMed
Timaru-Kast, R, Wyschkon, S, Luh, C, Schaible, EV, Lehmann, F, Merk, P, Werner, C, Engelhard, K, Thal, SC. Delayed inhibition of angiotensin II receptor type 1 reduces secondary brain damage and improves functional recovery after experimental brain trauma. Crit Care Med 2012;40(3):935–44.Google Scholar
Peng, W, Yang, J, Yang, B, Wang, L, Xiong, XG, Liang, Q. Impact of statins on cognitive deficits in adult male rodents after traumatic brain injury: a systematic review. Biomed Res Int 2014;2014:261409.CrossRefGoogle ScholarPubMed
Lesniak, A, Pick, CG, Misicka, A, Lipkowski, AW, Sacharczuk, M. Biphalin protects against cognitive deficits in a mouse model of mild traumatic brain injury (MTBI). Neuropharmacology 2016;101:506–18.Google Scholar
Robertson, CS, Garcia, R, Gaddam, SS, Grill, RJ, Cerami Hand, C, Tian, TS, Hannay, HJ. Treatment of mild traumatic brain injury with an erythropoietin-mimetic peptide. J Neurotrauma 2013;30(9):765–74.Google Scholar
Dewan, Y, Komolafe, EO, Mejia-Mantilla, JH, Perel, P, Roberts, I, Shakur, H, Collaborators, C. Crash-3 – tranexamic acid for the treatment of significant traumatic brain injury: study protocol for an international randomized, double-blind, placebo-controlled trial. Trials 2012;13(87):1–14.CrossRefGoogle ScholarPubMed
Julien, J, Tinawi, S, Anderson, K, Frenette, LC, Audrit, H, Ferland, MC, Feyz, M, De Guise, E. Highlighting the differences in post-traumatic symptoms between patients with complicated and uncomplicated mild traumatic brain injury and injured controls. Brain Inj 2017;31(13–14):1846–55.Google Scholar
van der Naalt, J, Timmerman, ME, de Koning, ME, van der Horn, HJ, Scheenen, ME, Jacobs, B, Hageman, G, Yilmaz, T, Roks, G, Spikman, JM. Early predictors of outcome after mild traumatic brain injury (upfront): an observational cohort study. Lancet Neurol 2017;16(7):532–40.CrossRefGoogle ScholarPubMed
Delouche, A, Attye, A, Heck, O, Grand, S, Kastler, A, Lamalle, L, Renard, F, Krainik, A. Diffusion MRI: pitfalls, literature review and future directions of research in mild traumatic brain injury. Eur J Radiol 2016;85(1):25–30.CrossRefGoogle ScholarPubMed
Topolovec-Vranic, J, Pollmann-Mudryj, MA, Ouchterlony, D, Klein, D, Spence, J, Romaschin, A, Rhind, S, Tien, HC, Baker, AJ. The value of serum biomarkers in prediction models of outcome after mild traumatic brain injury. J Trauma 2011;71(5 Suppl 1):S478–86.Google ScholarPubMed
Spaite, DW, Hu, C, Bobrow, BJ, Chikani, V, Barnhart, B, Gaither, JB, Denninghoff, KR, Adelson, PD, Keim, SM, Viscusi, C, Mullins, T, et al. The effect of combined out-of-hospital hypotension and hypoxia on mortality in major traumatic brain injury. Ann Emerg Med 2017;69(1):62–72.Google Scholar
Stiell, IG, Laupacis, A, Wells, GA, Canadian, CTH. Cervical-Spine Study G: indications for computed tomography after minor head injury. Canadian CT head and cervical-spine study group. N Engl J Med 2000;343(21):1570–1.Google Scholar
Kreitzer, N, Hart, K, Lindsell, CJ, Betham, B, Gozal, Y, Andaluz, NO, Lyons, MS, Bonomo, J, Adeoye, O. Factors associated with adverse outcomes in patients with traumatic intracranial hemorrhage and Glasgow Coma Scale of 15. Am J Emerg Med 2017;35(6):875–80.Google Scholar
Peck, KA, Calvo, RY, Schechter, MS, Sise, CB, Kahl, JE, Shackford, MC, Shackford, SR, Sise, MJ, Blaskiewicz, DJ. The impact of preinjury anticoagulants and prescription antiplatelet agents on outcomes in older patients with traumatic brain injury. J Trauma Acute Care Surg 2014;76(2):431–6.CrossRefGoogle ScholarPubMed
Fox, WC, Park, MS, Belverud, S, Klugh, A, Rivet, D, Tomlin, JM. Contemporary imaging of mild TBI: the journey toward diffusion tensor imaging to assess neuronal damage. Neurol Res 2013;35(3):223–32.Google ScholarPubMed
Hellstrom, T, Westlye, LT, Kaufmann, T, Trung Doan, N, Soberg, HL, Sigurdardottir, S, Nordhoy, W, Helseth, E, Andreassen, OA, Andelic, N. White matter microstructure is associated with functional, cognitive and emotional symptoms 12 months after mild traumatic brain injury. Sci Rep 2017;7(1):13795.Google Scholar
Oehr, L, Anderson, J. Diffusion-tensor imaging findings and cognitive function following hospitalized mixed-mechanism mild traumatic brain injury: a systematic review and meta-analysis. Arch Phys Med Rehabil 2017;98(11):2308–19.CrossRefGoogle ScholarPubMed
Mayer, AR, Bellgowan, PS, Hanlon, FM. Functional magnetic resonance imaging of mild traumatic brain injury. Neurosci Biobehav Rev 2015;49:8–18.CrossRefGoogle ScholarPubMed
Eierud, C, Craddock, RC, Fletcher, S, Aulakh, M, King-Casas, B, Kuehl, D, LaConte, SM. Neuroimaging after mild traumatic brain injury: review and meta-analysis. Neuroimage Clin 2014;4:283–94.CrossRefGoogle ScholarPubMed
Mayer, AR, Mannell, MV, Ling, J, Gasparovic, C, Yeo, RA. Functional connectivity in mild traumatic brain injury. Hum Brain Mapp 2011;32(11):1825–35.Google Scholar
Heidari, K, Vafaee, A, Rastekenari, AM, Taghizadeh, M, Shad, EG, Eley, R, Sinnott, M, Asadollahi, S. S100b protein as a screening tool for computed tomography findings after mild traumatic brain injury: systematic review and meta-analysis. Brain Inj 2015;29:1–12.Google ScholarPubMed
Posti, JP, Takala, RS, Runtti, H, Newcombe, VF, Outtrim, J, Katila, AJ, Frantzen, J, Ala-Seppala, H, Coles, JP, Hossain, MI, Kyllonen, A, et al. The levels of glial fibrillary acidic protein and ubiquitin C-terminal hydrolase-L1 during the first week after a traumatic brain injury: correlations with clinical and imaging findings. Neurosurgery 2016;79(3):456–64.Google Scholar
Heidari, K, Asadollahi, S, Jamshidian, M, Abrishamchi, SN, Nouroozi, M. Prediction of neuropsychological outcome after mild traumatic brain injury using clinical parameters, serum S100B protein and findings on computed tomography. Brain Inj 2015;29(1):33–40.Google Scholar
Okonkwo, DO, Yue, JK, Puccio, AM, Panczykowski, DM, Inoue, T, McMahon, PJ, Sorani, MD, Yuh, EL, Lingsma, HF, Maas, AI, Valadka, AB, et al. GFAP-BDP as an acute diagnostic marker in traumatic brain injury: results from the prospective transforming research and clinical knowledge in traumatic brain injury study. J Neurotrauma 2013;30(17):1490–7.Google Scholar
Yue, JK, Vassar, MJ, Lingsma, HF, Cooper, SR, Okonkwo, DO, Valadka, AB, Gordon, WA, Maas, AI, Mukherjee, P, Yuh, EL, Puccio, AM, et al. Transforming research and clinical knowledge in traumatic brain injury pilot: multicenter implementation of the common data elements for traumatic brain injury. J Neurotrauma 2013;30(22):1831–44.Google Scholar
Maas, AI, Menon, DK, Steyerberg, EW, Citerio, G, Lecky, F, Manley, GT, Hill, S, Legrand, V, Sorgner, A, Participants, C-T. Investigators: collaborative European neurotrauma effectiveness research in traumatic brain injury (center-TBI): a prospective longitudinal observational study. Neurosurgery 2015;76(1):67–80.Google Scholar
Ganti, L, Daneshvar, Y, Ayala, S, Bodhit, AN, Peters, KR. The value of neurocognitive testing for acute outcomes after mild traumatic brain injury. Mil Med Res 2016;3:23.Google Scholar
Thomas, DG, Collins, MW, Saladino, RA, Frank, V, Raab, J, Zuckerbraun, NS. Identifying neurocognitive deficits in adolescents following concussion. Acad Emerg Med 2011;18(3):246–54.Google Scholar
Hartwell, JL, Spalding, MC, Fletcher, B, O’Mara, MS, Karas, C. You cannot go home: routine concussion evaluation is not enough. Am Surg 2015;81(4):395–403.CrossRefGoogle ScholarPubMed
Foks, KA, Cnossen, MC, Dippel, DWJ, Maas, A, Menon, D, van der Naalt, J, Steyerberg, EW, Lingsma, H, Polinder, S. Management of mild traumatic brain injury at the emergency department and hospital admission in Europe: a survey of 71 neurotrauma centers participating in the center-TBI study. J Neurotrauma 2017;34.Google Scholar
Minor head injury discharge advice - adults. The Brain Injury Association. https://www.headway.org.uk/media/2767/minor-head-injury-discharge-advice.pdfGoogle Scholar
Gioia, GA. Medical-school partnership in guiding return to school following mild traumatic brain injury in youth. J Child Neurol 2016;31(1):93–108.Google Scholar
McCrory, P, Davis, G, Makdissi, M. Second impact syndrome or cerebral swelling after sporting head injury. Curr Sports Med Rep 2012;11(1):21–3.Google Scholar
Adult concussion management guidelines (routine). England Rugby 2017. https://www.englandrugby.com//dxdam/86/86c7a5b7-e65a-4f58-ae9c-3c3c1449b519/HEADCASE%20Adult%20Concussion%20Management%20Guidelines.pdfGoogle Scholar

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×