North Carolina Advocates for Justice Traumatic Brain Injury Seminar
On Friday morning I had the pleasure of lecturing at the North Carolina Advocates for Justice Traumatic Brain Injury seminar held at the Charlotte School of Law in Charlotte, North Carolina. My topic was handling the traumatic case.
The keynote speaker was Dr. Gregory O’Shanick, Medical Director of the Brain Injury Association-America. Dr. O’Shanick lectured on the myths of traumatic brain injury.
During the presentation, Dr. O’Shanick shared with the attendees various peer reviewed articles on various topics of traumatic brain injury.
In “Accuracy of Mild Traumatic Brain Injury Diagnosis” by Powell, et al., published in the Archives of Physical Medicine Rehabilitation, 2008; 89:1550-5, the researchers conducted a study to determine how often emergency room patients meeting the Center for Disease Control and Prevention (CDC) mild traumatic brain injury criteria were diagnosed with a mild TBI by emergency room physicians. This is an important study for neuro attorneys, as we often are faced with defense forensic courtroom doctors who testify that the plaintiff could not have sustained a brain injury as there was no mention of such a diagnosis in the emergency room records.
In this study, the researchers had study personnel, using scripted interviews and medical record data, compare the information with a retrospective review of emergency department medical record documentation of mild TBI. The researchers looked at a prospective cohort of 197 subjects with arrival at the emergency room within 48 hours of injury, a Glasgow Coma Scale (GCS) score of 13-15 and injury circumstances, alteration of consciousness, and memory dysfunction consistent with the CDC mild TBI definition. The study found that 56% of mild TBI cases identified by study personnel did not have a documented mild TBI-related diagnosis in the emergency room record. The greatest agreement between study personnel and emergency room physicians were positive mild TBI related findings was for lost of consciousness with the greatest discrepancy for confusion.
The authors concluded “the diagnosis of mild TBI was frequently absent from ED medical records despite patients’ reporting findings consistent with a mild TBI diagnosis.”
Dr. O’Shanick also shared another article entitled “Mild Traumatic Brain Injury: A Neuropsychiatric Approach to Diagnosis, Evaluation, and Treatment” by David B. Arciniegas, M.D., et al. published in Neuropsychiatric Disease and Treatment 2005:1(4) 311-327. There, the authors examined as the title suggests, the diagnosis, evaluation, and treatment of patients with mild traumatic brain injury. While this article is a must read for all neuro attorneys, what is most of interest in keeping with the theme of this blog is the authors statement “it is sometimes difficult to obtain reliable information regarding the occurrence and duration of loss of consciousness, PTA, alteration of mental status, and focal neurologic deficits from the individual with a possible TBI. Individuals will often misinterpret a period of PTA as a loss of consciousness: if events cannot be remembered, the erroneous assumption that one was unconscious during those events may be made. Similarly, the very nature of an alteration in consciousness may preclude accurate self-observation during that period. Thereby rendering any history obtained from the individual him or herself regarding the immediate injury period as difficult to interpret at best."
I would like to thank the organizers of the event for putting together a very informative program.