TY - JOUR
T1 - Expert Panel Survey to Update the American Congress of Rehabilitation Medicine Definition of Mild Traumatic Brain Injury
AU - ACRM Mild TBI Definition Expert Consensus Group and the ACRM Brain Injury Special Interest Group Mild TBI Task Force
AU - Silverberg, Noah D.
AU - Iverson, Grant L.
AU - Arciniegas, David B.
AU - Bayley, Mark T.
AU - Bazarian, Jeffrey J.
AU - Bell, Kathleen R.
AU - Broglio, Steven P.
AU - Cifu, David
AU - Davis, Gavin A.
AU - Dvorak, Jiri
AU - Echemendia, Ruben J.
AU - Gioia, Gerard A.
AU - Giza, Christopher C.
AU - Hinds, Sidney R.
AU - Katz, Douglas I.
AU - Kurowski, Brad G.
AU - Leddy, John J.
AU - Le Sage, Natalie
AU - Lumba-Brown, Angela
AU - Maas, Andrew I.R.
AU - Manley, Geoffrey T.
AU - McCrea, Michael
AU - McCrory, Paul
AU - Menon, David K.
AU - Putukian, Margot
AU - Suskauer, Stacy J.
AU - van der Naalt, Joukje
AU - Walker, William C.
AU - Yeates, Keith Owen
AU - Zafonte, Ross
AU - Zasler, Nathan
AU - Zemek, Roger
AU - Brown, Jessica
AU - Cogan, Alison
AU - Dams-O'Connor, Kristen
AU - Delmonico, Richard
AU - Park Graf, Min Jeong
AU - Iaccarino, Mary Alexis
AU - Kajankova, Maria
AU - Kamins, Joshua
AU - McCulloch, Karen L.
AU - McKinney, Gary
AU - Nagele, Drew
AU - Panenka, William J.
AU - Rabinowitz, Amanda R.
AU - Reed, Nick
AU - Wethe, Jennifer V.
AU - Whitehair, Victoria
N1 - Publisher Copyright:
© 2020 American Congress of Rehabilitation Medicine
PY - 2021/1
Y1 - 2021/1
N2 - Objective: As part of an initiative led by the Brain Injury Special Interest Group Mild Traumatic Brain Injury (TBI) Task Force of the American Congress of Rehabilitation Medicine (ACRM) to update the 1993 ACRM definition of mild TBI, the present study aimed to characterize current expert opinion on diagnostic considerations. Design: Cross-sectional web-based survey. Setting: Not applicable. Participants: An international, interdisciplinary group of clinician-scientists (N=31) with expertise in mild TBI completed the survey by invitation between May and July 2019 (100% completion rate). Interventions: Not applicable. Main Outcome Measures: Ratings of agreement with statements related to the diagnosis of mild TBI and ratings of the importance of various clinical signs, symptoms, test findings, and contextual factors for increasing the likelihood that the individual sustained a mild TBI, on a scale ranging from 1 (“not at all important”) to 10 (“extremely important”). Results: Men (n=25; 81%) and Americans (n=21; 68%) were over-represented in the sample. The survey revealed areas of expert agreement (eg, acute symptoms are diagnostically useful) and disagreement (eg, whether mild TBI with abnormal structural neuroimaging should be considered the same diagnostic entity as “concussion”). Observable signs were generally rated as more diagnostically important than subjective symptoms (Wilcoxon signed ranks test, Z=3.77; P<.001; r=0.68). Diagnostic importance ratings for individual symptoms varied widely, with some common postconcussion symptoms (eg, fatigue) rated as unhelpful (<75% of respondents indicated at least 5 out of 10 importance). Certain acute test findings (eg, cognitive and balance impairments) and contextual factors (eg, absence of confounds) were consistently rated as highly important for increasing the likelihood of a mild TBI diagnosis (≥75% of respondents indicated at least 7 out of 10). Conclusions: The expert survey findings identified several potential revisions to consider when updating the ACRM mild TBI definition, including preferentially weighing observable signs in a probabilistic framework, incorporating symptoms and test findings, and adding differential diagnosis considerations.
AB - Objective: As part of an initiative led by the Brain Injury Special Interest Group Mild Traumatic Brain Injury (TBI) Task Force of the American Congress of Rehabilitation Medicine (ACRM) to update the 1993 ACRM definition of mild TBI, the present study aimed to characterize current expert opinion on diagnostic considerations. Design: Cross-sectional web-based survey. Setting: Not applicable. Participants: An international, interdisciplinary group of clinician-scientists (N=31) with expertise in mild TBI completed the survey by invitation between May and July 2019 (100% completion rate). Interventions: Not applicable. Main Outcome Measures: Ratings of agreement with statements related to the diagnosis of mild TBI and ratings of the importance of various clinical signs, symptoms, test findings, and contextual factors for increasing the likelihood that the individual sustained a mild TBI, on a scale ranging from 1 (“not at all important”) to 10 (“extremely important”). Results: Men (n=25; 81%) and Americans (n=21; 68%) were over-represented in the sample. The survey revealed areas of expert agreement (eg, acute symptoms are diagnostically useful) and disagreement (eg, whether mild TBI with abnormal structural neuroimaging should be considered the same diagnostic entity as “concussion”). Observable signs were generally rated as more diagnostically important than subjective symptoms (Wilcoxon signed ranks test, Z=3.77; P<.001; r=0.68). Diagnostic importance ratings for individual symptoms varied widely, with some common postconcussion symptoms (eg, fatigue) rated as unhelpful (<75% of respondents indicated at least 5 out of 10 importance). Certain acute test findings (eg, cognitive and balance impairments) and contextual factors (eg, absence of confounds) were consistently rated as highly important for increasing the likelihood of a mild TBI diagnosis (≥75% of respondents indicated at least 7 out of 10). Conclusions: The expert survey findings identified several potential revisions to consider when updating the ACRM mild TBI definition, including preferentially weighing observable signs in a probabilistic framework, incorporating symptoms and test findings, and adding differential diagnosis considerations.
KW - Brain concussion
KW - Consensus
KW - Diagnosis
KW - Rehabilitation
KW - Surveys and questionnaires
KW - Traumatic brain injury
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U2 - 10.1016/j.apmr.2020.08.022
DO - 10.1016/j.apmr.2020.08.022
M3 - Article
C2 - 33035515
AN - SCOPUS:85095838460
SN - 0003-9993
VL - 102
SP - 76
EP - 86
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
IS - 1
ER -