Practice Management Guidelines for the Management of Mild Traumatic Brain Injury: The EAST Practice Management Guidelines Work Group

Mild traumatic brain injury (MTBI), or concussion, is a common cause for admission at trauma centers, particularly those centers admitting primarily blunt trauma victims. Represented by ICD-9-CM codes 850.0-850.9, MTBI may be generally defined as an injury caused by blunt acceleration/deceleration forces which produce a period of unconsciousness for 20 minutes or less and/or brief retrograde amnesia, a Glasgow Coma Scale score of 13 to 15, no focal neurological deficit, no intracranial complications (e.g. seizure activity), and normal computed tomography (CT) findings. 1-3 In 1995, MTBI ranked third behind only abrasions and contusions as the most common ICD-9 code at our institution. In the pediatric age groups, the diagnosis of concussion, as an isolated injury or as the most significant diagnosis, was the single most reason for admission. Despite the frequency of MTBI, there is no uniform agreement regarding the nature of the illness, the role of a variety of diagnostic tests, or the necessity of acute hospitalization. Neurotrauma textbooks and a large number of review articles have addressed the definition, epidemiology, and clinical characteristics of MTBI. 1-8