Mild, Moderate, and Severe Traumatic Brain Injuries

Traumatic Brain Injury / Head Injury

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March 9, 2022

Pinch me please! I just read an amazing report from the National Academies of Sciences, Engineering, and Medicine (NASEM) that has the potential to change our understanding and treatment of traumatic brain injuries.

Let me explain a little more. Traumatic brain injuries (TBI) are labeled as either “mild,” “moderate” or “severe”. While labels such as “severe” are useful in emergency situations, such as when someone has an active brain bleed that can be fatal, these labels can also limit care after the emergency phase is over and rehabilitation begins. On the other end of the spectrum, a “mild” TBI ( or mTBI) does not mean that the patient is symptom-free, that their symptoms will always resolve soon after the trauma, or that they do not need medical care. A “mild” TBI generally just means there is no brain bleed, and that there is no visible structural damage to the brain on scans.

Why does all of this matter? Unfortunately, the label of “mild” has been used by insurers to limit evaluation and treatment options. Insurance companies often argue that a mTBI is the same as minor injury, with no short-term or long-term functional difficulties, and they refuse to pay for treatment beyond a certain point.

The importance of this report is that it challenges the labels of mild-moderate-severe as “outdated, imprecise, and do not effectively serve patients, clinicians, or payers.” A new approach to classifying TBIs, the report notes, “would allow for more personalized care for patients, better ongoing monitoring of their condition, and more successful translation of therapies from research to the clinic.”

A label of mild-moderate-severe limits understanding that all TBIs are evolving conditions with different effects on different people, including many symptoms (headaches, dizziness and balance difficulties, fatigue, visual changes, sensitivity to sound or light, sleep problems, libido changes, memory issues, concentration problems, forgetfulness, mood swings, and problems with follow-through). As the report indicates, the current labels “promotes bias that can limit care… For example, someone with a “mild” TBI might have persistent symptoms, yet their treatment is withdrawn too soon.”

Words matter. In the medical field they matter even more, since words used in a diagnosis can set a course of treatment in action that can be difficult to change. For people suffering from TBIs, it is important that their treatment options remain as broad as possible, since mTBIs often result in many difficulties for patients, making their injuries seem anything but “mild.” It will be truly groundbreaking if this new way of thinking continues to gain momentum in both the medical and insurance worlds.

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