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Is ther a way to determine the severity of Brain Injury?
It is estimated that 70%–85% of all traumatic brain injuries fall into the mild TBI category. While they rarely require inpatient rehabilitation, patients commonly report cognitive and behavioral changes from which they recover within 3–6 months;17 10%–15% remain symptomatic in the longer term with a persisting post-concussion syndrome: physical complaints including headache, cervical pain, vestibular symptoms; changes in taste and hearing; difficulty with attention and memory; and irritability, insomnia and sleeping difficulties. Interpersonal relationships and work may also be affected. This large group of people with TBI can face many years of impairment, possibly affecting health, education, occupation, and social and emotional functioning.18,19 Treatment involves patient and family education, reassurance and psychological support.
Patients with moderate and severe traumatic brain injury show a broad range of possible outcomes, and it is generally not possible to predict the extent of recovery in the initial weeks after the trauma. Many patients with a dire early prognosis successfully return to competitive employment. Most will be independently mobile and be physically, if not cognitively, capable of self-care and normal community living.
With that said, some broad outcomes can be inferred from relatively simple injury severity markers.
The duration of Post-Traumatic Amnesia (PTA) is the best indicator of the extent of cognitive and functional deficits after TBI. PTA is defined as that period of time in which the brain is unable to lay down continuous day-to-day memory. In Australia, the most common means of assessing PTA is the Westmead PTA Scale. The duration of PTA can be used as a guide to outcome, and correlates well with the extent of DAI and with functional outcomes. For example, one study found 80% of patients with a PTA duration of less than 2 weeks had a good recovery, compared with 46% for those with a PTA duration between 4 and 6 weeks. Patients with additional hypoxic or ischaemic injury had a worse outcome for the same duration of coma.
The Glasgow Coma Scale (GCS) generates a score between 3 and 15 based on a person's abilities in eye opening and motor and verbal function. It is a quick and easy tool used to assess the severity of traumatic brain injury in the acute setting. The GCS gives a prognosis for survival rather than for functional outcomes.
Differentiating patients with a minimally responsive state from those with persistent vegetative states can be controversial for both clinical and legal reasons. Clinically, determining the cognitive capacity of a person with extremely severe motor deficits is a vexed issue requiring extended assessment. Persistent vegetative state indicates that the person, although showing signs of basic arousal, has been otherwise completely unable to interact with his or her environment for an extended period of time. True permanent vegetative states are now exceedingly rare, due to a reduction in incidence of the condition and improved methods of assessment, and most patients become at least minimally responsive over time. This return of some level of consciousness has major implications, particularly as many of these people are young and are managed in facilities with limited rehabilitation opportunities or in high-care residential aged-care facilities.