Edited by N. E. Gilhus, M. P. Barnes and M. Brainin © 2011 Blackwell Publishing Ltd. ISBN: 978-1-405-18533-2
EFNS GUIDELINES/CME ARTICLE
Mild traumatic brain injury
Article first published online: 19 JAN 2012
© 2012 The Author(s). European Journal of Neurology © 2012 EFNS
European Journal of Neurology
Volume 19, Issue 2, pages 191–198, February 2012
How to Cite
Vos, P. E., Alekseenko, Y., Battistin, L., Ehler, E., Gerstenbrand, F., Muresanu, D. F., Potapov, A., Stepan, C. A., Traubner, P., Vecsei, L. and von Wild, K. (2012), Mild traumatic brain injury. European Journal of Neurology, 19: 191–198. doi: 10.1111/j.1468-1331.2011.03581.x
This is a Continuing Medical Education article, and can be found with corresponding questions on the Internet at http://www.efns.org/EFNSContinuing-Medical-Education-online.301.0.html. Certificates for correctly answering the questions will be issued by the EFNS.
- Issue published online: 19 JAN 2012
- Article first published online: 19 JAN 2012
- Received 27 September 2011 Accepted 29 September 2011
- mild traumatic brain injury
Traumatic brain injury (TBI) is one among the most frequent neurological disorders. Of all TBIs 90% are considered mild with an annual incidence of 100–300/100 000. Intracranial complications of mild traumatic brain injury (MTBI) are infrequent (10%), requiring neurosurgical intervention in a minority of cases (1%), but potentially life threatening (case fatality rate 0.1%). Hence, a true health management problem exists because of the need to exclude the small chance of a life-threatening complication in a large number of individual patients. The 2002 EFNS guideline used the best evidence approach based on the literature until 2001 to guide initial management with respect to indications for computed tomography (CT), hospital admission, observation and follow-up of MTBI patients. This updated EFNS guideline for initial management in MTBI proposes a more selective strategy for CT when major [dangerous mechanism, Glasgow Coma Scale (GCS) < 15, 2 points deterioration on the GCS, clinical signs of (basal) skull fracture, vomiting, anticoagulation therapy, post-traumatic seizure] or minor (age, loss of consciousness, persistent anterograde amnesia, focal deficit, skull contusion, deterioration on the GCS) risk factors are present based on published decision rules with a high level of evidence. In addition, clinical decision rules for CT now exist for children as well. Since 2001, recommendations, although with a lower level of evidence, have been published for clinical observation in hospitals to prevent and treat other potential threats to the patient including behavioural disturbances (amnesia, confusion and agitation) and infection.