What is third grade concussion

Psychiatry, Psychosomatics & Psychotherapy

Diagnosis and classification of the severity of traumatic brain injuries

If a traumatic brain injury is suspected, the accident doctor will draw up a protocol at the scene of the accident. The neurological status is recorded at the scene of the accident, the motor function of all extremities and the initial level of consciousness are documented using the Glasgow Coma Score (GCS). A full set of all deployment protocols remains with the patient. In order to be able to clarify any questions that arise afterwards, the names of the emergency doctor and paramedic must be noted on the operational log.

After admission to the clinic, the first step is to check whether bleeding and open or blunt bone injuries have occurred. In this case, surgery is carried out immediately. Fractures of the skull can be caused by a X-ray examination determine, especially when the individual fragments are shifted against each other.

In order to rule out damage to the brain, a Computed tomogram (CT) of the skull made. The CT is also used to monitor the progression of swelling, secondary bleeding, CSF congestion, infarction or infection.

Monitoring the progression of an extra- or intradural hematoma, i.e. a bruise outside or inside the dura, is particularly important. The same applies to a bruise or contusion of the brain (contusion) as well as to cerebral edema or signs of such as an increase in pressure in the skull.

The Magnetic resonance imaging (MRI) is carried out in the case of severe craniocerebral injuries to diagnose damage (lesions), bruises, circulatory disorders (ischemia) of the brain or the urinary system (diabetes insipidus). The MRI is also used later to detect brain tissue defects, glian scars, ventricular dilation, chronic subdural hematoma or an abscess.

Under certain circumstances, further examination methods may be necessary: ​​Serve in the case of severe TBI evoked potentials a more accurate assessment of the patient's condition. With the MR angiography narrowing and injuries of blood vessels can be detected. Specific Ultrasound examinations (Neurosonography, transcranial Doppler sonography) are also used to detect disorders in blood vessels. Electroencephalography (EEG) is used to control the dosage of anesthetics and to detect epilepsy-related disorders in the brain.

A general physical examination will determine the extent to which skeletal, soft tissue, or organ injuries have occurred. The cervical vertebral column deserves special attention after traumatic brain injuries, it must be immobilized until the final clarification.

The severity of the trauma can be determined on the basis of the examinations described and the protocol of the accident doctor. Only after the examinations can the doctors say where and to what extent injuries have occurred and what effects (including secondary and late effects of the trauma) are to be expected.

Classification of degrees of severity in traumatic brain injuries

The severity of a traumatic brain injury is usually determined according to the score in the Glasgow Coma Scale (GCS) assigned. On this scale, the patient receives points for certain reactions. Criteria are opening eyes, verbal reaction to speech and motor reaction. During the preliminary examination at the scene of the accident, opening eyes, reactions to painful stimuli and verbal utterances by the accident victim are recorded. The observations result in a point value between 3 and 15, with 15 being the highest possible number of points in the GCS. The severity of the damage caused is accordingly divided into three degrees of severity:

GCS value from 13 - 15: Mild traumatic brain injury (SHT 1)

Brief loss of consciousness that does not last more than 5 minutes. Symptoms resolve within a few days. There is usually a memory gap for the time before or after the damaging event. No long-term effects are to be expected. A so-called post-commotional syndrome may occur, but this regresses after a while. A slight traumatic brain injury is also referred to as a concussion (commotio cerebri). However, since complications can arise even with an initially harmless-looking traumatic brain injury, the patient may have to be observed in the hospital or at home.

GCS value of 9 - 12: Moderate traumatic brain injury (TBI 2)

Unconsciousness lasts for more than 5 minutes up to 30 minutes. Symptoms resolve within a month; Long-term consequences are unlikely. Here, too, the patient should be observed further in the initial period after the accident in order to avoid possible complications.

GCS value from 3 - 8: Severe traumatic brain injury (SHT 3)

Unconsciousness for more than 30 minutes; damage usually persists in the event of a severe traumatic brain injury.

More than three quarters (approx. 80%) of the TBI patients referred to a clinic have a mild TBI that has no further consequences. Another 10% are moderately affected and another 10% are severely affected.

Post-commotional syndrome

Term for general symptoms after a concussion that can last for a few weeks and gradually resolve. This leads to apathy, diffuse headache, dizziness, nausea, rapid fatigue and irritability as well as increased sweating.

Technical support: Dr. med. Uwe Meier (BDN), Grevenbroich