Concussion definition
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Definition
No single definition of concussion, mild head injury,[1] or mild traumatic brain injury is universally accepted, though a variety of definitions have been offered.[2] In 2001, the first International Symposium on Concussion in Sport was organized by the International Olympic Committee Medical Commission and other sports federations. A group of experts called the Concussion in Sport Group met there and defined concussion as "a complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces."[3] They agreed that concussion typically involves temporary impairment of neurological function which quickly resolves by itself, and that neuroimaging normally shows no gross structural changes to the brain as the result of the condition.
According to the classic definition, no structural brain damage occurs in concussion;[4] it is a functional state, as symptoms are caused primarily by temporary biochemical changes in neurons that take place, for example, at their cell membranes and synapses. However, in recent years researchers have included injuries in which structural damage does occur under the umbrella of concussion. According to the National Institute for Health and Clinical Excellence definition, concussion may involve a physiological or physical disruption in the brain's synapses.[5]
Definitions of mild traumatic brain injury (MTBI) have been inconsistent since the 1970s, but the World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD-10) described MTBI-related conditions in 1992, providing a consistent, authoritative definition across specialties. In 1993, the American Congress of Rehabilitation Medicine defined MTBI as 30 minutes or fewer of loss of consciousness (LOC), 24 hours or fewer of post-traumatic amnesia (PTA), and a Glasgow Coma Scale (GCS) score of at least 13.[6] In 1994, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders defined MTBI using PTA and LOC. Other definitions of MTBI incorporate focal neurological deficit and altered mental status, in addition to PTA and GCS.[2]
Although the term "concussion" is still used in sports literature as interchangeable with "MHI" or "MTBI", the general clinical medical literature now uses "MTBI" instead.[7]
Controversy exists about whether the definition of concussion should include only those injuries in whichloss of consciousness occurs. Historically, concussion by definition involved a loss of consciousness, but the definition has changed over time to include a change in consciousness, such as amnesia.[8] The best-known concussion grading scales count head injuries in which loss of consciousness does not occur to be mild concussions and those in which it does to be more severe.
References
- ↑ Satz P, Zaucha K, McCleary C, Light R, Asarnow R, Becker D (1997). "Mild head injury in children and adolescents: A review of studies (1970–1995)". Psychological Bulletin. 122 (2): 107–131. PMID 9283296.
- ↑ 2.0 2.1
Comper P, Bisschop SM, Carnide N, Tricco A (2005). "A systematic review of treatments for mild traumatic brain injury". Brain Injury. 19 (11): 863–880. doi:10.1080-0269050400025042 Check
|doi=value (help). ISSN 0269-9052. PMID 16296570. - ↑ Cantu RC (2006). "An overview of concussion consensus statements since 2000" (PDF). Neurosurgical Focus. 21 (4:E3): 1–6.
- ↑ Parkinson D (1999). "Concussion confusion". Critical Reviews in Neurosurgery. 9 (6): 335–339. doi:10.1007/s003290050153. ISSN 1433-0377.
- ↑ "Head Injury: Triage, Assessment, Investigation and Early Management of Head Injury in Infants, Children and Adults" (PDF). National Institute for Health and Clinical Excellence. September 2007. ISBN 0-9549760-5-3. Retrieved 2008-01-26.
- ↑ Kushner D (1998). "Mild Traumatic brain injury: Toward understanding manifestations and treatment". Archives of Internal Medicine. 158 (15): 1617–1624. PMID 9701095.
- ↑ Barth JT, Varney NR, Ruchinskas RA, Francis JP (1999). "Mild head injury: The new frontier in sports medicine". In Varney NR, Roberts RJ. The Evaluation and Treatment of Mild Traumatic Brain Injury. Hillsdale, New Jersey: Lawrence Erlbaum Associates. pp. 85–86. ISBN 0-8058-2394-8. Retrieved 2008-03-06.
- ↑ Ruff RM, Grant I (1999). "Postconcussional disorder: Background to DSM-IV and future considerations". In Varney NR, Roberts RJ. The Evaluation and Treatment of Mild Traumatic Brain Injury. Hillsdale, New Jersey: Lawrence Erlbaum Associates. p. 320. ISBN 0-8058-2394-8.