Mild Traumatic Brain Injury: National Consensus Clinical Recommendations
DOI:
https://doi.org/10.20344/amp.24437Keywords:
Biomarkers, Brain Injuries, Traumatic/diagnosis, Brain Injuries, Traumatic/diagnostic imaging, Brain Injuries, Traumatic/drug therapyAbstract
Mild traumatic brain injury accounts for approximately 80% of cranial trauma worldwide. Despite its apparent benign nature, it is associated with high costs and sequelae. The evaluation of victims should follow a logic of severity stratification to guide subsequent management decisions. The systematic use of computed tomography is consensual as a diagnostic tool in moderate or severe cases, but it remains controversial in mild cases. In recent years, serum biomarkers have emerged as an objective and complementary tool in risk stratification for injury. Glial fibrillary acidic protein and ubiquitin C-terminal hydrolase L1 assist decision-making in patients with a Glasgow Coma Scale score between 14 and 15 within the first 12 hours after trauma. This consensus aims to establish a decision algorithm based on the combination of clinical scores such as the Canadian CT Head Rule (high sensitivity) and biomarkers. The main objective of the algorithm is to standardize the approach based on evidence and seek to reduce exposure to radiation and time spent in the Emergency Department, while simultaneously allowing safe clinical discharge. In moderate-risk cases, when glial fibrillary acidic protein and ubiquitin C-terminal hydrolase L1 are negative within the first 12 hours after trauma, the need for cranio-encephalic computed tomography is excluded due to the high negative predictive value of these biomarkers, allowing discharge unless another clinical indication exists. All high-risk patients will undergo cranio-encephalic computed tomography; those under antithrombotic therapy will additionally undergo biomarker testing. Both results negative allow consideration of discharge; both results positive imply admission. If the Computed Tomography is negative and at least one biomarker is positive, the following is suggested: repetition of Cranio-Encephalic Computed Tomography in patients aged 75 years or older, due to elevated serum values even in the absence of trauma in 95% of this subgroup and the current absence of age-adjusted cut-offs; biomarkers should be repeated if age is below 75 years. This consensus also aims to present a new proposed classification of traumatic brain injury that seeks a more complete and individualized characterization.
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