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DVBCWTB5.m

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  1. DVBCWTB5 ;ALB/RLC TRAUMATIC BRAIN INJURY (TBI) WKS TEXT - 4 ; 12 FEB 2007
  1.  ;;2.7;AMIE;**183**;Apr 10, 1995;Build 8
  1.  ;
  1.  ;
  1. TXT ;
  1.  ;;                      DEFINITION OF TRAUMATIC BRAIN INJURY
  1.  ;;
  1.  ;;A traumatically induced structural injury and/or physiological disruption of
  1.  ;;brain function as a result of an external force that is indicated by new onset
  1.  ;;or worsening of at least one of the following clinical signs, immediately
  1.  ;;following the event:
  1.  ;;
  1.  ;;   -  Any period of loss of or a decreased level of consciousness;
  1.  ;;
  1.  ;;   -  Any loss of memory for events immediately before or after injury;
  1.  ;;
  1.  ;;   -  Any alteration in mental state at the time of the injury (confusion,
  1.  ;;      disorientation, slowed thinking, etc.);
  1.  ;;
  1.  ;;   -  Neurological deficits (weakness, loss of balance, change in vision,
  1.  ;;      praxis, paresis/plegia, sensory loss, aphasia, etc.) that may or may not
  1.  ;;      be transient;
  1.  ;;
  1.  ;;   -  Intracranial lesion.
  1.  ;;
  1.  ;;External forces may include any of the following events:  the head being struck
  1.  ;;by an object, the head striking an object, the brain undergoing an
  1.  ;;acceleration/deceleration movement without direct external trauma to the head,
  1.  ;;a foreign body penetrating the brain, forces generated from events such as a
  1.  ;;blast or explosion, or other force yet to be defined.
  1.  ;;
  1.  ;;The above criteria define the event of a traumatic brain injury (TBI).
  1.  ;;Sequelae of TBI may resolve quickly, within minutes to hours after the
  1.  ;;neurological event, or they may persist longer.  Some sequelae of TBI may be
  1.  ;;permanent.  Most signs and symptoms will manifest immediately following the
  1.  ;;event.  However, other signs and symptoms may be delayed from days to months
  1.  ;;(e.g., subdural hematoma, seizures, hydrocephalus, spasticity, etc.).  Signs
  1.  ;;and symptoms may occur alone or in varying combinations and may result in a
  1.  ;;functional impairment.  These signs and symptoms are not better explained by
  1.  ;;pre-existing conditions or other medical, neurological, or psychological causes
  1.  ;;except in cases of an exacerbation of a pre-existing condition.  These
  1.  ;;generally fall into one or more of the three following categories:
  1.  ;;
  1.  ;;   -  PHYSICAL:  Headache, nausea, vomiting, dizziness, blurred vision, sleep
  1.  ;;      disturbance, weakness, paresis/plegia, sensory loss, spasticity, aphasia,
  1.  ;;      dysphagia, dysarthria, apraxia, balance disorders, disorders of
  1.  ;;      coordination, seizure disorder.
  1.  ;;
  1.  ;;   -  COGNITIVE:  Attention, concentration, memory, speed of processing, new
  1.  ;;      learning, planning, reasoning, judgment, executive control, self-
  1.  ;;      awareness, language, abstract thinking.
  1.  ;;
  1.  ;;   -  BEHAVIORAL/EMOTIONAL:  Depression, anxiety, agitation, irritability,
  1.  ;;      impulsivity, aggression.
  1.  ;;
  1.  ;;Note:  The signs and symptoms listed above are typical of each category but
  1.  ;;are not an exhaustive list of all possible signs and symptoms.
  1.  ;;
  1.  ;;SEVERITY OF BRAIN INJURY STRATIFICATION:
  1.  ;;
  1.  ;;Not all individuals exposed to an external force will sustain a TBI.  TBI
  1.  ;;varies in severity, traditionally described as mild, moderate and severe.
  1.  ;;These categories are based on measures of length of unconsciousness, post-
  1.  ;;traumatic amnesia.
  1.  ;;
  1.  ;;The trauma may cause structural damage or may produce more subtle damage that
  1.  ;;manifests by altered brain function, without structural damage that can be
  1.  ;;detected by traditional imaging studies such as Magnetic Resonance Imaging or
  1.  ;;Computed Tomography scanning.  In addition to traditional imaging studies,
  1.  ;;other imaging techniques such as functional magnetic resonance imaging,
  1.  ;;diffusion tensor imaging, positron emission tomography scanning, as well as
  1.  ;;electrophysiological testing such as electroencephalography may be used to
  1.  ;;detect damage to or physiological alteration of brain function.  In addition,
  1.  ;;altered brain function may be manifest by altered performance on neuro-
  1.  ;;psychological or other standardized testing of function.
  1.  ;;
  1.  ;;Acute injury severity is determined at the time of the injury, but this
  1.  ;;severity level, while having some prognostic value, does not necessarily
  1.  ;;reflect the patient's ultimate level of functioning.  It is recognized that
  1.  ;;serial assessments of the patient's cognitive, emotional, behavioral and
  1.  ;;social functioning is required.
  1.  ;;
  1.  ;;   -  The patient is classified as mild/moderate/severe if he or she meets any
  1.  ;;      of the criteria below within a particular severity level.  If a patient
  1.  ;;      meets criteria in more than one category of severity, the higher severity
  1.  ;;      level is assigned.
  1.  ;;
  1.  ;;   -  If it is not clinically possible to determine the brain injury level of
  1.  ;;      severity because of medical complications (e.g., medically induced coma),
  1.  ;;      other severity markers are required to make a determination of the
  1.  ;;      severity of the brain injury.
  1.  ;;
  1.  ;;TOF
  1.  ;;      ___________________________________________________________
  1.  ;;     | Mild             | Moderate           | Severe            |
  1.  ;;     |________________  |________________    |___________________|
  1.  ;;     | Normal structural| Normal or abnormal | Normal or abnormal|
  1.  ;;     | imaging          | structural imaging | structural imaging|
  1.  ;;     |__________________|____________________|___________________|
  1.  ;;     | LOC = 0-30 min*  | LOC > 30 min and   | LOC > 24 hrs      |
  1.  ;;     |                  | < 24 hours         |                   |
  1.  ;;     |__________________|____________________|___________________|
  1.  ;;     | AOC = a moment   | AOC >24 hours. Severity based on other |
  1.  ;;     | up to 24 hrs     | criteria                               |
  1.  ;;     |__________________|________________________________________|
  1.  ;;     | PTA = 0-1 day    | PTA > 1 and < 7    | PTA > 7 days      |
  1.  ;;     |                  | days               |                   |
  1.  ;;     |__________________|____________________|___________________|
  1.  ;;      AOC - Alteration of consciousness/mental state
  1.  ;;      LOC - Loss of consciousness
  1.  ;;      PTA - Post-traumatic amnesia
  1.  ;;
  1.  ;;It is recognized that the cognitive symptoms associated with post-traumatic
  1.  ;;stress disorder (PTSD) may overlap with symptoms of mild TBI.  Differential
  1.  ;;diagnosis of brain injury and PTSD is required for accurate diagnosis and
  1.  ;;treatment.
  1.  ;;END