Mild Traumatic Brain Injury: An Update for Advanced Practice Nurses

Esther Bay, PhD APRN BC CCRN; Samuel A. McLean, MD MPH


J Neurosci Nurs. 2007;39(1):43-51. 

In This Article

Abstract and Introduction

Nearly 75% of persons with brain injury experience a mild injury. These people do not often enter the healthcare system by traditional means, nor do they always present with visible signs and symptoms of injury. In fact, people who experienced brain trauma are likely to seek help in primary care settings and from advanced practice nurses (APNs). Because the symptom experience can be complicated by impaired perception or mood, delays in seeking help, and faulty explanations for their symptoms, APNs need to rule out competing diagnoses, offer brief psychoeducational treatment, and refer the person to an appropriate specialist for therapy when needed.

Traumatic brain injury (TBI) affects people of all ages, is expensive, has varying levels of severity, and contributes to disability. The majority of those injured are 18-25 years of age (National Institute of Health [NIH] Consensus Statement, 1999). Conservative estimates of lifetime costs associated with TBI approach $56 billion (Thurman, 2001).

Mild brain injury (MBI) accounts for 75% of all diagnosed head injuries (Bazarian et al., 2005; de Kruijk et al., 2002) and costs the nation nearly $17 billion each year (Centers for Disease Control and Prevention [CDC], 2003). MBI can be treated in emergency department (ED) settings, yet it is estimated that about 25% of those with MBI fail to seek medical attention (Shah, Bazarian, Mattingly, Davis, & Schneider, 2004). The CDC refers to MBI as a "silent epidemic" because the problems experienced by patients with MBI (e.g., dizziness, headache, and memory disturbance) are often not visible and may result in functional loss, and are more difficult for practitioners to detect. Long-term physical, mental, social, or occupational consequences may result (McCauley, Boake, Levin, Contant, & Song, 2001; Ruffolo, Friedland, Dawson, Colantonio, & Lindsay, 1999; van der Naalt, van Zomeren, Sluiter, & Minderhoud, 1999).

These patients often do not enter the health system through traditional means (CDC, 2003). Instead, their first help-seeking visit may be an ambulatory clinic, substance abuse support group, or primary care office. Advanced practice nurses (APNs) are in key positions to assess for MBI, provide brief psycho-educational interventions about the consequences and trajectory of brain trauma, and make appropriate referrals. Screening for the presence of brain injury should be done with reliable screening tools and effective interviewing techniques. To accomplish this goal, the APN must understand the reasons the patient may enter the health system and be prepared to detect undiagnosed MBI. This article describes the CDC MBI Screening Tool (CDC, 2003), discusses the symptom experience of the person with MBI, identifies potential differential diagnoses, and provides an overview of diagnostic tests and evidence-based treatment for persons with MBI.


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