VA/DoD CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF CONCUSSION-MILD TRAUMATIC BRAIN INJURY
Department of Veterans Affairs Department of Defense
Patient Guide
QUALIFYING STATEMENTS
The Department of Veterans Affairs and the Department of Defense guidelines are based upon the best information available at the time of publication. They are designed to provide information and assist decision making. They are not intended to define a standard of care and should not be construed as one. Neither should they be interpreted as prescribing an exclusive course of management. The Clinical Practice Guideline is based on a systematic review of both clinical and epidemiological evidence. Developed by a panel of multidisciplinary experts, it provides a clear explanation of the logical relationships between various care options and health outcomes while rating both the quality of the evidence and the strength of the recommendations. Variations in practice will inevitably and appropriately occur when clinicians take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice. Every healthcare professional making use of these guidelines is responsible for evaluating the appropriateness of applying them in the setting of any particular clinical situation. The guidelines are not intended to represent TRICARE policy. Further, inclusion of recommendations for specific testing and/or therapeutic interventions within these guidelines does not guarantee coverage of civilian sector care. Additional information on current TRICARE benefits may be found at www.tricare.mil or by contacting your regional TRICARE Managed Care Support Contractor.
Version 2.0 – 2016
I. What is concussion (mild traumatic brain injury)?
A traumatic brain injury (TBI) is a head injury caused by a blow or jolt to the head that affects the normal function of the brain. TBI can be mild, moderate or severe, depending on how long the injury effects last. A concussion, also known as a mild TBI (mTBI), is the most common type of TBI.
If you experienced a concussion, you will have had a short loss or alteration of consciousness and at least one of the following:[1,2]
- Forgetting the events before or after the injury
- Confusion, disorientation, or slowed thinking right after the injury
- Weakness, dizziness, unsteady on feet, change in vision, difficulty completing movements, numbness, or trouble finding words
II. What symptoms should I watch for?
You may have experienced one or more of the following symptoms in the days that followed the injury:
- Headache
- Decreased awareness of your surroundings
- Double vision
- Unsteady on feet
- Disorientation/confusion
- Weakness or numbness in the arms and legs
If any of the above symptoms change or worsen, or if you develop new symptoms, such as seizures, vomiting, worsening vision, or slurred speech, contact your health care provider immediately.
Did You Know?
- The Centers for Disease Control and Prevention (CDC) estimate that approximately 2.2 million emergency department visits and 50,000 deaths occur annually due to TBI.[1]
- The Defense and Veterans Brain Injury Center (DVBIC) estimates that over 1.7 million people sustain a TBI every year in the United States; about 84% of TBIs are classified as mild severity or concussion.[3]
III. How is Concussion/mTBI Diagnosed?
Concussion is diagnosed by your health care provider based on the history of the injury, how it occurred, how long you passed out and other factors, including a physical exam. You should discuss any symptoms you may have with your doctor to determine whether they are associated with your injury.
IV. How is Concussion/mTBI Treated?
Generally, patients make a full recovery from a concussive injury without treatment. Recovery is different for each patient, but symptoms usually improve within hours and resolve completely within a few days or weeks after injury. If you have symptoms that continue to impact your daily activities, you should talk to your provider about treatment options. Talk to your doctor, nurse practitioner, physician assistant, pharmacist or other healthcare provider about appropriate approaches to treating your symptoms.
V. References
- Centers for Disease Control Prevention; National Center for Injury Prevention and Control; Division of Unintentional Injury Prevention. Report to congress on traumatic brain injury in the United States: Epidemiology and rehabilitation. Atlanta, GA: Centers for Disease Control Prevention; 2014.
- Assistant Secretary of Defense. Traumatic brain injury: Updated definition and reporting. Washington, DC: Department of Defense; 2015.
- Defense and Veterans Brain Injury Center. About traumatic brain injury. Silver Spring, MD: 2015. https://dvbic.dcoe.mil/about-tbi/about-traumatic-brain-injury?audience[0]=1. Updated February 2, 2016. Accessed February 2, 2016.