Patients with suspected concussive injury are categorized as having mild traumatic brain injury, or mTBI if, when they are first seen by an emergency medicine provider, they receive a score of 14-15 on the 15-point Glasgow Coma Scale, which is used to determine level of consciousness based on responses to various stimuli:
Modified Glasgow Coma Scale
|Motor Response||The patient obeys commands||6
|The patient responds to a painful stimulus by moving toward the site of the stimulus||5
|The patient moves away from a painful stimulus||4|
|The patient flexes his or her joints in response to a painful stimuli
|The patient extends his or her joints in response to a painful stimuli
|The patient has no response to a painful stimuli||1
|Verbal Response||The patient is able to respond appropriately to questions regarding who he or she is and where he or she is||5|
|The patient responds to questions, but is confused||4
|The patient responds to questioning using inappropriate words. There is no conversation||3|
|The patient makes incomprehensible sounds, but no actual words
|No response to questioning
||The patient spontaneously opens his or her eyes
| The patient opens his or her eyes to speech
| The patient opens his or her eyes to painful stimulus
| The patient does not open his or her eyes, despite painful stimulus
|Total possible score
Does not measure concussion severity
Because most concussion victims score 14 or 15 on the GCS, its primary utility is in ruling out more serious brain injuries.4 Thus, "[w]hile highly useful in the sphere of emergency response to trauma, the Glasgow Coma Scale should not be used to assess the significance of a concussion," writes William P. Meehan, III, MD, MomsTeam concussion medicine expert and Director of the Sports Concussion Clinic in the Division of Sports Medicine at Children's Hospital Boston, in his new book, Kids, Sports, and Concussion.1
The reason is "because it does not predict how long it will take an athlete to recover from a concussion. Many patients who are diagnosed with mild traumatic brain injury have diminished brain function, headaches and other symptoms that last for weeks or even months. Alternatively," he notes, "some patients diagnosed with 'moderate' traumatic brain injury will recover completely within days to weeks."
mTBI and concussion: not interchangeable terms
As a result, Dr. Meehan argues that "the term mild traumatic brain injury should not be used interchangeably with concussion," as suggested by the authors of a 2010 Canadian study,2 which found that how a brain injury was labeled made a difference when it came to treatment, and suggested that, to encourage full reporting of head injuries in sports and to allow adequate management and recovery time, MTBI be used in its place.
While acknowledging that the [Canadian] study "highlighted a general misinterpretation that an injury described as a concussion is less severe than one described as mTBI," and that it may result in a premature return to school and activity," the American Academy of Pediatrics' 2010 clinical report on sports-related concussion in children and teens3 continues to refer to the injury as concussion.
Lisa L. Bakhos, M.D., a Pediatric Emergency Medicine Attending at Jersey Shore University Medical Center in Neptune, New Jersey and the lead author of a new study on concussions in pediatric and adolescent athletes, told MomsTeam that the reason was that "neurologists and sports medicine specialists give concussion a very specific definition," such that "[s]ufferers have to meet certain criteria to be considered "concussed," with the term mTBI reserved for mild head injuries that do not meet the definition of concussion.
1. Meehan, WP III. Kids, Sports, and Concussion: A Guide for Coaches and Parents (Praeger 2011) at 7-8.
2. Dematteo CA, Hanna SE, Mahoney WJ. et al. My child doesn't have a brain injury, he only has a concussion. Pediatrics 2010;125(2):327-334.
3. Halstead, M, Walter, K, Clinical Report - Sport-Related Concussion in Children and Adolescents, Pediatrics 2010;126 (3): 597-607.
4. Dziemianowicz M, Kirschen MP, Pukenas BA, Laudano E, Balcer LJ, Galetta SL. Sport-Related Concussion Testing. Curr Neurol Neurosci Rep 2012 (published online July 13, 2012)(DOI:10.1007/s11910-012-0299-y).
Updated and revised July 17, 2012