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Loss of consciousness
If unwitnessed, must distinguish from posttraumatic
amnesia. Difficult to assess when intubated, sedated, or intoxicated.
Momentary to several hours
Can fluctuate, wax, and wane. Individual may appear
stunned, dazed, confused, and/or disoriented.
Often absent or very brief.
Individual may report patchy recollections. Ends with
return of continuous, sequential memory. Difficult to assess when
intubated, sedated, or intoxicated.
May have visual disturbance, language difficulty, impact
seizure. Often no signs evident other than disturbance of consciousness
Glasgow Coma Scale
Score of 13–15 thirty minutes after the event
Difficult to assess when intubated, sedated, or intoxicated.
Individual may report headache, nausea, dizziness,
sensitivity to light/noise, cognitive problems.
American Congress of Rehabilitation Medicine (Kay et al. 1993)
A traumatically induced physiological disruption of brain
Any loss of consciousness less than 30 minutes
Any alteration in mental state at the time of the accident
(e.g., feeling dazed, disoriented, or confused)
Any loss of memory for events immediately before or
after the accident
Focal neurological deficit(s) that may or may not be
After 30 minutes, an initial Glasgow Coma Scale score
of 13–15, posttraumatic amnesia not greater than 24 hours
Centers for Disease Control and Prevention (2003)
Injury to the head resulting from blunt trauma or acceleration
or deceleration forces
Observed or self-reported loss of consciousness lasting
30 minutes or less
Observed or self-reported transient confusion, disorientation,
or impaired consciousness
Observed or self-reported dysfunction of memory (amnesia) around
the time of injury
Observed signs of other neurological or neuropsychological dysfunction,
such as seizures acutely following head injury; among infants/very young
children: irritability, lethargy, or vomiting
World Health Organization (Carroll et al. 2004)
An acute brain injury resulting from mechanical energy
to the head from external physical forces
Loss of consciousness for 30 minutes or less
Confusion or disorientation
Posttraumatic amnesia for less than 24 hours
Transient neurological abnormalities such as focal
signs, seizure, and intracranial lesion not requiring surgery
Glasgow Coma Scale score of 13–15 after 30 minutes
must not be due to drugs, alcohol, medications, caused by other injuries
or treatment for other injuries
ICD-criteria for postconcussional syndrome
A history of
TBI and the presence of three or more of the following eight symptoms:
Intolerance of stress, emotion, or alcohol
for postconcussional disorder
of TBI causing "significant cerebral concussion"
deficit in attention and/or memory
of at least three of the following eight symptoms that appear after
injury and persist for 3 months:
that begin or worsen after injury
of sufficient severity to interfere with social role functioning
not better explained by dementia due to head trauma and another
Source. American Psychiatric Association 2000; World Health Organization 1992.