Position Statement: Definition of Traumatic Brain Injury

doi:10.1016/j.apmr.2010.05.017

Archives of Physical Medicine and Rehabilitation

Volume 91, Issue 11, November 2010, Pages 1637-1640

https://doi.org/10.1016/j.apmr.2010.05.017 Get rights and content

Abstract

Menon DK, Schwab K, Wright DW, Maas AI, on behalf of The Demographics and Clinical Assessment Working Group of the International and Interagency Initiative toward Common Data Elements for Research on Traumatic Brain Injury and Psychological Health. Position statement: definition of traumatic brain injury.

A clear, concise definition of traumatic brain injury (TBI) is fundamental for reporting, comparison, and interpretation of studies on TBI. Changing epidemiologic patterns, an increasing recognition of significance of mild TBI, and a better understanding of the subtler neurocognitive neuroaffective deficits that may result from these injuries make this need even more critical. The Demographics and Clinical Assessment Working Group of the International and Interagency Initiative toward Common Data Elements for Research on Traumatic Brain Injury and Psychological Health has therefore formed an expert group that proposes the following definition:

TBI is defined as an alteration in brain function, or other evidence of brain pathology, caused by an external force.

In this article, we discuss criteria for considering or establishing a diagnosis of TBI, with a particular focus on the problems how a diagnosis of TBI can be made when patients present late after injury and how mild TBI may be differentiated from non-TBI causes with similar symptoms. Technologic advances in magnetic resonance imaging and the development of biomarkers offer potential for improving diagnostic accuracy in these situations.

Section snippets

TBI Definition

TBI is defined as an alteration in brain function, or other evidence of brain pathology, caused by an external force.

Explanatory Notes

[A] Alteration in brain function is defined as 1 of the following clinical signs:

•
Any period of loss of or a decreased LOC
•
Any loss of memory for events immediately before (retrograde amnesia) or after the injury (PTA)
•
Neurologic deficits (weakness, loss of balance, change in vision, dyspraxia paresis/plegia [paralysis], sensory loss, aphasia, etc.)
•
Any alteration in mental state at the time of the injury (confusion, disorientation, slowed thinking, etc.)

It is important to recognize that factors

Discussion

Clear-cut definitions and unambiguous diagnostic criteria are prerequisites for epidemiology, clinical care, and research in any disease. Yet little attention has been paid in the literature to defining TBI, and many clinicians feel that the term is self-explanatory. The gradual change in terminology from “head injury” to “traumatic brain injury” reflects the understanding that it is the damage to the brain that matters, and not so the damage to scalp or skull. The importance of injury to the

References (16)

R.E. Jorge et al.
Hippocampal volume and mood disorders after traumatic brain injury
Biol Psychiatry
(2007)
P.M. Kochanek et al.
A critical problem begging for new insight and new therapies
J Neurotrauma
(2009)
R.M. Ruff et al.
Recommendations for diagnosing a mild traumatic brain injury: a National Academy of Neuropsychology Education paper
Arch Clin Neuropsychol
(2009)
J.M. Silver et al.
Depression and cognitive complaints following mild traumatic brain injury
Am J Psychiatry
(2009)
NINDS Common Data Elements
Clinical Practice Guideline: Management of Concussion/mild Traumatic Brain Injury
Definition of mild traumatic brain injury
J Head Trauma Rehabil
(1993)
L.J. Carroll et al.
Methodological issues and research recommendations for mild traumatic brain injury: the WHO Collaborating Task Force on Mild Traumatic Brain Injury
J Rehabil Med
(2004)

There are more references available in the full text version of this article.

Cited by (1110)

Traumatic brain injury or traumatic brain disease: A scientific commentary
2024, Brain Multiphysics
Traumatic Brain Injury (TBI) represents a major public health burden and a major contributor to disability and death, especially in the young population. It remains one of the most challenging human conditions to classify and the non-standardized classification is one of the numerous barriers in proper diagnosis and effective translation of experimental treatments in animal models. TBI is associated with numerous disorders, including amnesia, Parkinson's Disease, sleep disorders, Alzheimer's Disease, as well as disruption of physical, cognitive, and mental functioning. Several health care providers and the insurance industry see TBI as a singular 'event', meaning that the brain ''repairs'' over time, and does not require additional therapies. However, a single mild TBI can induce problems that self-propagate for months or years after the injury. There currently exist no diagnostic methods to quantify the extent of emotional and behavioral changes, cognitive impairment, fatigue, and sleep issues resulting from TBI in affected individual. The various animal and injury models available for TBI research are limited in clinical trials because a single TBI event is not fully understood. This review highlights the classifications of TBI, its heterogeneity, neuropathological lesions, long term sequelae, association with neurodegenerative disorders in human and animal studies, and attempts to modify the notion of TBI being viewed as a singular event.
The significance and strength of this review article lies in its comprehensive exploration of Traumatic Brain Injury (TBI) by addressing various factors that contribute to its complexity. We carried out a careful and detailed review of TBI classifications with an aim to provide a clearer and more detailed understanding of the heterogeneity inherent in these injuries. The examination of neuropathological lesions associated with TBI offers critical insights into the intricate nature of brain damage, fostering a deeper comprehension of the diverse outcomes resulting from TBI.
Furthermore, this review critically evaluates the long-term sequelae of TBI, shedding light on the often-overlooked extended consequences that impact individuals well beyond the initial injury period. The findings from human and animal studies not only enriches our understanding of TBI but also highlights the translational implications for both clinical and preclinical research.
A pivotal aspect of our review involves investigating the association between TBI and neurodegenerative disorders. By combining information from human studies and animal models, we aim to contribute to the growing body of knowledge that elucidates the intricate links between TBI and the development of neurodegenerative conditions.
Most notably, this review challenges the conventional notion of TBI as a singular event by incorporating perspectives that emphasize its multifaceted nature. We critically assess attempts to modify this prevailing paradigm, encouraging a more nuanced understanding that considers the diverse manifestations and outcomes associated with TBI.
In essence, this review endeavours to serve as a valuable resource for researchers, clinicians, and policymakers, fostering a comprehensive understanding of TBI that transcends traditional classifications and contributes to a more holistic approach in both research and clinical practice.
Causal association between years of schooling and the risk of traumatic brain injury: A two-sample mendelian randomization analysis
2024, Journal of Affective Disorders
To investigate whether the number of years of schooling are causally associated traumatic brain injury (TBI). We aimed to investigate whether the number of years of schooling are causally associated TBI.
We investigate the prospective causal effect of years of schooling on TBI using summary statistical data. The statistical dataset comprising years of schooling (n = 293,723) from genome-wide association studies (GWASs) deposited in the UK Biobank was used for exposure. We used the following GWAS available in the FinnGen dataset: individuals with TBI (total = 13,165; control = 136,576; number of single nucleotide polymorphisms [SNPs] = 16,380,088).
Seventy significant genome-wide SNPs from GWAS datasets with annotated years of schooling were selected as instrumental variables. The inverse variance weighted method results supported a causal relationship between years of schooling and TBI (odds ratio (OR), 0.78; 95 % confidence interval (CI), 0.62–0.98; P = 0.029). MR-Egger regression showed that polydirectionality was unlikely to bias the results (intercept = 0.007, SE = 0.01, P = 0.484) and demonstrated no causal relationship between years of schooling and TBI (OR, 0.52; 95%CI, 0.17–1.64; P = 0.270). The weighted median method revealed a causal relationship with TBI (OR, 0.73; 95%CI, 0.55–0.98; P = 0.047). A Cochran's Q test and funnel plot did not show heterogeneity nor asymmetry, indicating no directional pleiotropy.
The current investigation yields substantiation of a causal association between years of schooling and TBI development. More years of schooling may be causally associated with a reduced risk of TBI, which has implications for clinical and public health practices and policies.
Chitosan revokes controlled-cortical impact generated neurological aberrations in circadian disrupted mice via TLR4-NLRP3 axis
2024, European Journal of Pharmacology
The severity of inevitable neurological deficits and long-term psychiatric disorders in the aftermath of traumatic brain injury is influenced by pre-injury biological factors. Herein, we investigated the therapeutic effect of chitosan lactate on neurological and psychiatric aberrations inflicted by circadian disruption (CD) and controlled-cortical impact (CCI) injury in mice. Firstly, CD was developed in mice by altering sporadic day-night cycles for 2 weeks. Then, CCI surgery was performed using a stereotaxic ImpactOne device. Mice subjected to CCI displayed a significant disruption of motor coordination at 1-, 3- and 5-days post-injury (DPI) in the rotarod test. These animals showed anxiety- and depression-like behaviors in the elevated plus maze and forced-swim test at 14 and 15 DPI, respectively. Notably, mice subjected to CD + CCI exhibited severe cognitive impairment in Y-maze and novel object recognition tasks. The compromised neurological, psychiatric, and cognitive functions were mitigated in chitosan-treated mice (1 and 3 mg/mL). Immunohistochemistry and real-time PCR assay results revealed the magnified responses of prima facie biomarkers like glial-fibrillary acidic protein and ionized calcium-binding adaptor molecule 1 in the pericontusional brain region of the CD + CCI group, indicating aggravated inflammation. We also noted the depleted levels of brain-derived neurotrophic factor and augmented expression of toll-like receptor 4 (TLR4)-leucine-rich-containing family pyrin domain-containing 3 (NLRP3) signaling [apoptosis-associated-speck-like protein (ASC), caspase-1, and interleukin 1-β] in the pericontusional area of CD + CCI group. CCI-induced changes in the astrocyte-glia and aggravated immune responses were ameliorated in chitosan-treated mice. These results suggest that the neuroprotective effect of chitosan in CCI-induced brain injury may be mediated by inhibition of the TLR4-NLRP3 axis.
The Role of Neuropsychology in Traumatic Brain Injury: Comprehensive Literature Review
2024, World Neurosurgery
Traumatic brain injury (TBI) is a major public health concern, often leading to significant behavioral and cognitive changes with subsequent impairment in daily functioning and personal interactions. The management of TBI involves a multidisciplinary approach. Neuropsychology has emerged as a critical discipline in assessing, diagnosing, treating, and rehabilitating individuals with TBI. Successful management also requires careful consideration of the patient's cognitive status. Therefore, clinicians must have a comprehensive understanding of the overall clinical picture of the patient at the cognitive and physical level. The primary aim of this research is to explore the role of neuropsychology in TBI management and rehabilitation thoroughly while providing an updated review of the literature. Various neuropsychological assessment tools used to evaluate cognitive functioning in individuals with TBI will be discussed in addition to their validity, reliability, and usefulness in identifying cognitive deficits and developing individualized treatment plans. The findings in this article will have significant implications on the clinical practice of neuropsychology in TBI patients, highlighting the importance of neuropsychological assessment in optimizing the management of this population. The need for increased awareness of neuropsychology among health care professionals, especially in the acute hospital setting, is growing along with the increase in diagnosis of TBI and its complications. Adequate understanding of the complex interplay between cognitive, emotional, and behavioral factors in TBI can inform the development of new interventions and treatment strategies, making it equally as important for patients and their families.
sTBI-GAN: An adversarial learning approach for data synthesis on traumatic brain segmentation
2024, Computerized Medical Imaging and Graphics
Automatic brain segmentation of magnetic resonance images (MRIs) from severe traumatic brain injury (sTBI) patients is critical for brain abnormality assessments and brain network analysis. Construction of sTBI brain segmentation model requires manually annotated MR scans of sTBI patients, which becomes a challenging problem as it is quite impractical to implement sufficient annotations for sTBI images with large deformations and lesion erosion. Data augmentation techniques can be applied to alleviate the issue of limited training samples. However, conventional data augmentation strategies such as spatial and intensity transformation are unable to synthesize the deformation and lesions in traumatic brains, which limits the performance of the subsequent segmentation task. To address these issues, we propose a novel medical image inpainting model named sTBI-GAN to synthesize labeled sTBI MR scans by adversarial inpainting. The main strength of our sTBI-GAN method is that it can generate sTBI images and corresponding labels simultaneously, which has not been achieved in previous inpainting methods for medical images. We first generate the inpainted image under the guidance of edge information following a coarse-to-fine manner, and then the synthesized MR image is used as the prior for label inpainting. Furthermore, we introduce a registration-based template augmentation pipeline to increase the diversity of the synthesized image pairs and enhance the capacity of data augmentation. Experimental results show that the proposed sTBI-GAN method can synthesize high-quality labeled sTBI images, which greatly improves the 2D and 3D traumatic brain segmentation performance compared with the alternatives. Code is available at .
Emotional Resilience Predicts Preserved White Matter Microstructure Following Mild Traumatic Brain Injury
2024, Biological Psychiatry: Cognitive Neuroscience and Neuroimaging
Adult patients with mild traumatic brain injury (mTBI) exhibit distinct phenotypes of emotional and cognitive functioning identified by latent profile analysis of clinical neuropsychological assessments. When discerned early after injury, these latent clinical profiles have been found to improve prediction of long-term outcomes from mTBI. The present study hypothesized that white matter (WM) microstructure is better preserved in an emotionally resilient mTBI phenotype compared with a neuropsychiatrically distressed mTBI phenotype.
The present study used diffusion magnetic resonance imaging to investigate and compare WM microstructure in major association, projection, and commissural tracts between the two phenotypes and over time. Diffusion magnetic resonance images from 172 patients with mTBI were analyzed to compute individual diffusion tensor imaging maps at 2 weeks and 6 months after injury.
By comparing the diffusion tensor imaging parameters between the two phenotypes at global, regional, and voxel levels, emotionally resilient patients were shown to have higher axial diffusivity compared with neuropsychiatrically distressed patients early after mTBI. Longitudinal analysis revealed greater compromise of WM microstructure in neuropsychiatrically distressed patients, with greater decrease of global axial diffusivity and more widespread decrease of regional axial diffusivity during the first 6 months after injury compared with emotionally resilient patients.
These results provide neuroimaging evidence of WM microstructural differences underpinning mTBI phenotypes identified from neuropsychological assessments and show differing longitudinal trajectories of these biological effects. These findings suggest that diffusion magnetic resonance imaging can provide short- and long-term imaging biomarkers of resilience.

View all citing articles on Scopus

: Supported by the National Institute of Neurological Disorders and Stroke (NINDS), the National Institute on Disability and Rehabilitation Research, the Department of Veterans Affairs, the Defense and Veterans Brain Injury Center, and the Defense Centers of Excellence, the Medical Research Council (RG46503), the National Institute for Health Research, United Kingdom (RG53668), the BOC Professorship of the Royal College of Anaesthetists (RG42458), the NIH-NINDS (NS 062778A, NS 059032-01, TW 007262-01), the Wallace H. Coulter Foundation, the Division of Emergency Neurosciences, Department of Emergency Medicine at Emory University, the NIH-NINDS (NS 42691), and the Flemish Institute for promoting Innovation in Science and Technology.

: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

: Views expressed are those of the authors and do not necessarily reflect those of the agencies or institutions with which they are affiliated, including the U.S. Department of Veterans Affairs, the U.S. Department of Defense, the U.S. Department of Health and Human Services, the National Institutes of Health, the National Institute of Mental Health, and the Uniformed Services University of the Health Sciences. This work is not an official document, guidance, or policy of the U.S. Government, nor should any official endorsement be inferred.

: Reprints are not available from the authors.

View full text

Special communicationPosition Statement: Definition of Traumatic Brain Injury

Abstract

Section snippets

TBI Definition

Explanatory Notes

Discussion

Biol Psychiatry

A critical problem begging for new insight and new therapies

J Neurotrauma

Recommendations for diagnosing a mild traumatic brain injury: a National Academy of Neuropsychology Education paper

Arch Clin Neuropsychol

Depression and cognitive complaints following mild traumatic brain injury

Am J Psychiatry

NINDS Common Data Elements

Clinical Practice Guideline: Management of Concussion/mild Traumatic Brain Injury

Definition of mild traumatic brain injury

J Head Trauma Rehabil

Methodological issues and research recommendations for mild traumatic brain injury: the WHO Collaborating Task Force on Mild Traumatic Brain Injury

J Rehabil Med

Special communication
Position Statement: Definition of Traumatic Brain Injury