Traumatic Brain Injury (TBI): Overview of Diagnosis and Treatment

Abstract

Objective: To provide an overview of literature on the diagnosis and rehabilitation of adults following traumatic\rbrain injury (TBI).\rMethod: A comprehensive systematic search identified current literature in TBI diagnosis and rehabilitation\rinterventions. Included studies were examined to identify current standards for diagnostic criteria for TBI in clinical\rand research contexts, and to present evidence for rehabilitation treatments in TBI.\rResults: Strong agreement exists for a diagnosis of TBI in the presence of post traumatic amnesia (PTA) following\rhead trauma; and that Glasgow Coma Score (GCS) of 9-12 is moderate TBI, and GCS of 3-8 is severe TBI. There\ris no agreement for whether GCS of 13 should be mild or moderate TBI; which GCS to use to grade TBI severity;\rwhich clinical feature (aside from PTA) indicates a diagnosis of mild TBI; and whether imaging findings should be incorporated into diagnostic criteria for TBI and for severity grading. Nomenclature for TBI type in the literature remains disorganised, which is problematic for TBI research. There is strong evidence for effectiveness of psychological interventions such as attention training and cognitive interventions after TBI; nutritional support for improved survival and disability outcomes and hyperbaric oxygen therapy for reduction of risk of death after TBI. There is moderate evidence for cognitive behaviour therapy for managing stress after mild TBI. For all other interventions the evidence is limited or insufficient due to lack of studies in the area.\rConclusion: Clear diagnostic criteria for TBI could improve management using targeted therapies. More robust trials in TBI treatments are needed to build evidence for effectiveness of rehabilitation.