By: Stephen Saris, M.D.
Over the past decade, allegations of concussion have become commonplace in personal injury claims. I would estimate that they occur in 20% of the hundreds of slip/fall and vehicular cases that I have reviewed during that time. A concussion expert can review the pertinent information, usually gleaned from the first 24 hours after the subject accident, to determine if the claimant meets the diagnostic criteria. In my experience, less than half of claimants who claim a minimal traumatic brain injury (mTBI) meet these criteria.
What is a concussion?
A concussion is a layperson’s term, and not a medical one. The medical term is traumatic brain injury. TBI can be minimal, moderate, or severe (see table below). The vast majority of TBIs are minimal traumatic brain injuries, and cases involving these will require an expert witness in this area.
Classification of mTBI Severity
Widely cited references on the classification of mTBI are the Department of Defense (DOD), the World Health Organization (WHO), the American Association of Neurological Surgery (AANS), American Association of Neurology (AAN), and the Centers for Disease Control (CDC). The DOD, WHO, AANS, and AAN require mechanical injury to the head such as a shrapnel or blast wave injury.
Carroll, L.J., Cassidy, J.D., Peloso, P.M., et al. Prognosis for mild traumatic brain injury: Results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Journal of Rehabilitation Medicine, 43 Supplement, 84-105.
If a head injury has occurred, one of the following has to occur prior to arriving at the diagnosis of an mTBI:
• Disorientation. Patient doesn’t know who they are, when it is, or where they are.
• Loss of consciousness for 30 minutes or less.
• No memory of what occurred after the trauma (Post-traumatic amnesia)
• Temporary nerve damage
• Glasgow coma scale (GCS) less than 15*
These need to be documented by a health care provider. One cannot self-report these clinical conditions, in particular loss of consciousness.
What is the natural history of mTBIs?
Even if the claimant has suffered an mTBI, recovery to normal is usually rapid and complete. The time frame of relief of related symptoms and signs is weeks.
See Acute effects and recovering time following concussion. JAMA volume 290, number 19.V 290:2256-2563, 2003; Michael Makdissi, David Darby, et al. Natural History of Concussion in Sport. American Journal of Sports Medicine 38: 464-471, 2010; Michael McCrea, Kevin Guskiewicz. JAMA 290:2556-2563, 2003; American Academy of Neurology. The Management of Concussion Summary Statement. American Academy of Neurology. 2008-01-28.
Conclusion
An mTBI expert witness knowledgeable about this condition may be a valuable resource during litigation where a mild traumatic brain injury is alleged.
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Stephen C. Saris, MD is a board-certified neurosurgeon who practices in both Massachusetts and Rhode Island. His practice involves both brain and spine. He has seen thousands of referrals of TBI from emergency rooms dating back to the 1980s. For many years he evaluated veterans returning from the Middle East with TBIs, often from IEDs. He has lectured on TBI at Harvard Medical School (Brigham and Women’s Hospital Grand Rounds).
Office: 401.453.3545 • Fax: 401.453.3533 • Cell: 401.378.2921
Website: www.neurosurgery-associates.com
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* The GCS is commonly used throughout hospitals in the United States, and indicates how significant a brain injury has occurred. Only a score of 15 is normal. It is determined by the patient’s ability to speak, move and see.
