A Surprisingly High Percentage of Uncomplicated MTBIs have Persistent Deficits and Require Ongoing Therapy
The April, 2015 issue of The American Surgeon reports on a retrospective study of 395 patients admitted to the ER following concussions (MTBI, or mild traumatic brain injury). The patients had “normal” Glascow Coma scores of 15 and normal CT scans and therefore met discharge criteria. The study found that a surprisingly high percentage of these patients (27%) had persistent deficits after neurocognitive testing and benefitted from referral for ongoing therapy. The study is authored by Hartwell et. al. and entitled “You Cannot Go Home: Routine Concussion Evaluation is Not Enough.”
The authors report that in their Columbus, Ohio medical centers this study has led to “a heightened awareness of persistent MTBI symptoms” and to routine early neurocognitive screening of MTBI patients in the acute setting. The authors found no predictors of persistent symptoms that could be used in the ER setting other than neurocognitive testing – whether or not the patient had lost consciousness was of no predictive value. This study builds on prior authority, referenced in the report, that “up to 15 to 40 percent of patients will experience symptoms and report persistent deficits for a year or longer.” For these patients, early identification and early intervention is important to improve long term outcomes.
As previously discussed in this blog, there has been controversy in the past concerning whether or not persistent symptoms following concussion are physiological or only psychological. Scientific developments over the last several years (as also discussed in this blog) have left very little doubt that in a substantial subset of patients, a concussion leads to changes in the brain and that these changes can cause symptoms that persist and in some cases get worse over time. This new report highlights the importance of changing ER protocols to recognize this understanding, identify patients with neurocognitive deficits and provide appropriate early intervention.
I would submit that there are both physiological and psychological causes for the persistence of concussion symptoms. In my case, three years post a “moderate” TBI, I am still struggling with depression and fighting it by keeping physically active. I’ve had in my past 2 undiagnosed TBI’s (one at age 13 included black out and stitches to the forehead and the second at age 21 from totaling my car- my head was one massive bruise.) From my own personal experience:
1) My latest TBI occurred in most likely a scarred region of my brain; my previous superficial scar was used to anchor the sutures of the repair of my most recent TBI. This last TBI was definitely a life changing event.
2) My latest TBI was followed by 3 successive reparative surgeries, each of which included exposure to general anesthesia. Coming to after my third surgery, I experienced symptoms similar to immediately following my original TBI.
3) Experiencing severe depression 1 1/2 years following my latest TBI produced an overall feeling of returning to Day 1 of the TBI.
4) I believe that the stressful, negative, emotionally-draining work environment I was surrounded by (for a 6 month period) after only a year of recovery, inhibited or even reversed my progress towards healing.
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