Definitions

The term mild head injury has been linked to other descriptors, disorders, and controversial concepts, such as minor head injury, mild traumatic brain injury, complicated mild head injury, cerebral concussion, postconcussion disorder, posttraumatic stress disorder, somatization disorder, compensation neurosis, the silent epidemic, and the miserable minority. In the early 1980s, investigators at the University of Virginia used the following criteria to define their mild head injury research population: head injury with Glasgow Coma Scale greater than 12, loss of consciousness of less than 20 min, and hospitalization less than 48 hr. This research definition was later expanded to include the absence of neuroimaging evidence of cerebral lesion(s). Variations of this definition with minor modifications have been the mainstay for mild head injury and concussion research ever since.

In 1993, controversy arose when a special-interest group of the American Congress of Rehabilitation Medicine (ACRM) published a definition for mild traumatic brain injury. Although it was similar to the previous research definition of mild head injury, it included factors such as alterations in consciousness or mental state at the time of the accident and posttrau-matic amnesia less than 24 hr. Of note, neither the ACRM nor the research definition require loss of consciousness or neuroimaging evidence of impairment. Table I presents the clinical criteria for mild traumatic brain injury. The ACRM definition goes on to state that medical, cognitive, and emotional symptoms of this mild brain injury may persist (the development of postconcussion disorder) and may produce functional disability. The symptoms of post-concussive disorder are presented in Table II.

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