After more than 50 years, the neuroscience research community agrees it’s finally time to update how traumatic brain injuries (TBIs) are assessed and diagnosed.
A new proposal, spearheaded by researchers at the University of California, San Francisco, expands diagnosis criteria beyond the traditional Glasgow Coma Scale (GSC) to include more measurements, including biomarkers, brain imaging, and other factors, like what caused the injury and relevant medical conditions.
“There are patients diagnosed with concussion whose symptoms are dismissed and receive no follow-up because it’s ‘only’ concussion, and they go on to live with debilitating symptoms that destroy their quality of life,” explains the study’s corresponding author Geoffrey Manley, MD, PhD, a professor of neurosurgery at USF, in a news release about the proposal. “On the other hand, there are patients diagnosed with ‘severe TBI’ who were eventually able to live full lives after their families were asked to consider removing life-sustaining treatment.”
TBIs are among the most common injuries in bicycle accidents. While some mild TBIs resolve quickly, others are far from their “mild” signifier and linger for months or years.
One Bay Area Bicycle Law, P.C. client who was hit by a car making a faulty right turn experienced symptoms, including fatigue, difficulty concentrating, headache, weakness, nausea, loss of coordination, and others. The client was unable to return to work months after the crash and instead spent their days in occupational therapy sessions. Even though they were wearing a helmet, it wasn’t enough to prevent a life-altering TBI.
Getting an accurate TBI diagnosis and valuable follow-up care can be challenging for some cyclists after a crash, sometimes because of the diagnosis framework. Researchers now say a new approach is needed for characterizing TBI more accurately. This could be extremely beneficial for cyclists who experience TBI symptoms and need additional resources to heal or manage symptoms.
More than the Glasgow Coma Scale
Currently, TBIs are commonly classified according to the GCS. A sum score of 13-15 is considered a mild TBI, moderate is 9-12, and a severe TBI lands between 3 and 8 on the scale. Concussions are often considered to be mild, but they can be serious. Some health agencies are even classifying TBIs as “chronic” conditions now.
The researchers’ new framework assessment proposal includes four pillars: clinical, biomarker, imaging, and modifiers. Together, researchers believe these assessment measurements will be a major step forward for patients.
“We will be much better equipped to match patients to treatments that give them the best chance of survival, recovery, and return to normal life function,” says co-senior author Michael McCrea, PhD, professor of neurosurgery and co-director of the Center for Neurotrauma Research at the Medical College of Wisconsin in Milwaukee.
While the clinical pillar will keep the GSC total score as a central element of the assessment, there will be other considerations, too. Like, measuring consciousness and pupil reactivity, response to eye, verbal, and motor commands or stimuli, and other symptoms, such as headache, amnesia, and dizziness.
The other pillars — using biomarkers, imaging, and considering other factors of the injury and patient — add upon the assessment. Blood tests, for example, can reveal biomarkers that “provide objective indicators of tissue damage, overcoming the limitations of clinical assessment that may inadvertently include symptoms unrelated to TBI,” according to the USF news release. This can guide doctors to perform only the necessary imaging and avoid exposing patients to unnecessary radiation and costly health care bills.
Many cyclists already know that no two TBIs are exactly the same, but it’s largely unknown what causes those differences. As a result, truly individualized care can be uncommon. Researchers behind the proposal, however, say that would change with the new framework.
“This pillar should be assessed as first priority in all patients,” says proposal co-senior author Andrew Maas, MD, PhD, emeritus professor of neurosurgery at the Antwerp University Hospital and University of Antwerp, Belgium. “Research has shown that the elements of this pillar are highly predictive of injury severity and patient outcome.”
Improving scientific discovery related to TBI
The new framework assessment would also provide a sturdy foundation for more research that could improve TBI care.
“The (framework) provides a multidimensional characterization of TBI to inform individualized clinical management and to improve scientific rigor,” the team of researchers say in the proposal.
Before more in-depth TBI work can begin, however, it’s up to scientists to verify the framework is as sound as they propose it will be in assessing TBI. Researchers say their priorities currently include validation of the framework itself, applicability beyond acute TBI, and strategies for clinical implementation.
Currently, the proposed framework is being phased in at trauma centers on a trial basis, according to USF. It will then be refined and validated before it is fully implemented.
This means all cyclists shouldn’t expect a change in their TBI assessment immediately, but that progress is in the works and more holistic treatment options could also be on the way.
Because TBIs can differ so greatly from person to person, it’s important to seek out professional care after a crash. Early detection and diagnosis may help long term. We know how stressful a crash and the events that follow, like seeking the right medical care, can be. This is why we are personal injury attorneys who specialize in the nuances of bicycle cases. With us, you’ll get the legal support you need so you can focus on recovering.
If you’ve been involved in a crash, the bicycle attorneys at Bay Area Bicycle Law can help navigate your rights, responsibilities, and options. Schedule your free consultation today.