The final pillar requires taking an extensive medical and social history of the patient to look for factors likely to affect recovery time. People who are older, women and those with a history of concussions, headaches or mental health problems usually take longer to recover.
“If you don’t ask about these elements, you may miss an opportunity to offer a more realistic prognosis to the patient,” said Dr. Cathra Halabi, director of UCSF’s Neurorecovery Clinic, which includes a program focused on people in the first six months after a traumatic brain injury.
While the new TBI assessment framework is geared primarily toward physicians treating people in acute settings within the first 24 hours of an injury, Halabi said it extends naturally to clinicians like her who see people longer term in an outpatient setting.
More detailed assessments will help doctors better determine who needs urgent care and who doesn’t, who needs follow-up care and who doesn’t. They also have the potential to improve clinical trials, bringing more precision to patient selection and a better likelihood of discovering new effective treatments.
Under the current system, Halabi frequently receives patient charts from the ER that say, “Bicycle accident, mild TBI.”
She expects the new classification will yield a thorough diagnostic description along the lines of: “Thirty-year-old woman, helmeted bicycle accident, blunt head injury, brief loss of consciousness, peritraumatic amnesia. CT scan negative for bleeding. Experiencing double vision, emotional dysregulation. History of migraines and depression.”
The additional data will inform Halabi how to properly care for this patient from the moment she comes into her clinic, and to be on the lookout for lingering and emerging symptoms like sleep impairments or endocrine dysfunction that could complicate healing.
“I’ve seen all sorts of bicycle accidents with mild TBI and every single person is different,” she said. “Unless you really ask and probe a bit more deeply on the other side of the acute phase, you may miss an opportunity to find an element of the case that’s going to help make that person recover.”
