Journal Club: When is a traumatic brain injury a "concussion?"

With no standard definition of the term "concussion," particularly with regard to children, investigators examined the clinical correlates of the concussion diagnosis and identified factors that lead clinicians to use the term. The authors prospectively collected data for 434 children with traumatic brain injury (TBI) who were admitted to a tertiary children's hospital in Canada. Glasgow Coma Scale (GCS) scores and initial computed tomography (CT) results also were available for 268 study participants.

A normal CT scan result was the greatest predictor of being labeled as having a concussion, especially when combined with some loss of consciousness. Only 20% of children with abnormal CT findings received a concussion label, although the presence of vomiting or disorientation increased the likelihood of the diagnosis in these children.

The concussion label also was more likely to be applied to children with mild TBIs, as indicated by mild GCS scores of 13 to 15, than to those with moderate or severe GCS scores. This association was weak, however; more than 62% of the children with mild scores were not labeled as having a concussion, and 24% of those with moderate or severe GCS scores were.

Commentary

The message I took away from this article is that we should stop using the term "concussion." It is confusing and used inconsistently. "Mild traumatic brain injury" conveys a more consistent message to parents and coaches: These injuries should not be taken lightly and require careful assessment before a child returns to full activity on the playing field and in school. For a useful toolkit on head injury in your practice, see the CDC's Heads Up program at http://www.cdc.gov/ncipc/tbi/physicians_tool_kit.htm.-MB