The American Congress of Rehabilitation Medicine Diagnostic Criteria for Mild Traumatic Brain Injury
Silverberg ND, Iverson GL; ACRM Brain Injury Special Interest Group Mild TBI Task Force and the ACRM Mild TBI Definition Expert Consensus Group, ACRM Brain Injury Special Interest Group Mild TBI Task Force members; et al. Arch Phys Med Rehabil. 2023 May 19:S0003-9993(23)00297-6. doi: 10.1016/j.apmr.2023.03.036. Epub ahead of print. PMID: 37211140.
The authors developed new diagnostic criteria for mild traumatic brain injuries that can be used across the lifespan and in sports, military settings, and civilian trauma. Boxes 1 and 2 offer the diagnostic criteria.
My name is Cassidy Fox, I am a second-year student in the MSAT program at James Madison University. I personally suffered my 6th concussion last November and am still dealing with life altering effects – I agree very strongly that there is a need for a unified diagnostic criterion for TBI’s in order to provide improved and consistent patient centered care (something the 8+ doctors I personally saw did not share). With many different health professional fields learning different ways to evaluate a concussion/mild TBI on the sideline of a field, in a clinician’s office, the emergency room, etc., it is clear that some professions may be better at certain aspects than others. For example, a neuro-optometrist will pick up on visual issues/symptoms and their causes much easier and faster than say an AT, PA or nurse. This is due to their specialized training of the eye itself, something other fields don’t hone in on. Another example of specialty may include how much closer of a relationship AT’s have with their athletes after day-to-day interactions. This makes it easier to pick up on when an athlete is in pain, trying to hide their pain, not acting their usual selves, etc. Many people can pass a concussion test through lying, but an AT who knows their athletes versus a clinic nurse who has never met them before may not pick up on differences in processing speeds, personality, tone of voice, facial expressions (or lack of) … The ACRM diagnostic criteria for mild TBI’s paints a very clear picture of who is, is not, or may be a candidate for injury. This can and will help clinicians to be sure we all act in the same way, looking for the same signs, working off the same definitions, all to be providing the best care possible. The ACRM criteria also stated what kind of concussion can be considered a mild TBI – I was not previously aware that only a concussion with normal or not clinically indicated neuroimaging could be considered a mild TBI. I appreciate the “one or more clinical signs” box as, often, many people find an excuse for a telling sign in order to continue playing/participating… One sign should be enough to hold an individual out in order to avoid second impact syndrome or other future complications. I also appreciate the statement acknowledging any suspected mild TBI to have occurred should be treated as if one did for at least the first few days following injury (immediately pulling from activity and completing a RTP protocol). Overall, this new set of criteria will be very beneficial for all health professionals, and I thoroughly enjoyed reading your study.