Dr. Jamshid Ghajar: Complex Project to Define Concussion
The medical definition of "concussion" needs be quantitative and non-static. It also needs to have clinical utility.
See more of Dr. Ghajar's videos here.
Well, the definition has got to have some clinical utility, obviously. And the other thing is we've all accepted the fact that a medical definition has got to be quantitative in some way. In other words, if you just have subjective signs, it's very difficult to get a handle on them. I mean, one of the most common things that a neurologist sees in their office are headache and dizziness. Well, that's what we see with people with traumatic brain injury, but you see that in migraine, you see that in a lot of other neurological conditions. How specific is that to traumatic brain injury? These are the kinds of things we have to sort through and see not only what the prevalence--is it a higher prevalence after a head injury? And how do those signs, symptoms, neurological or cognitive impairments relate to each other? If somebody has a headache after a presumed head injury, are they more likely to have a cognitive deficit? We need to look at all those associations, and even imaging, MRIs, CT scan, biomarkers and so on, how do they relate to these signs, symptoms, neurocognitive deficits? So, it's a very--I could say very challenging undertaking. We have a great methodology group. Nancy Carney heads up the Brain Trauma Foundation Guidelines Group in Oregon. They are very experienced in doing evidence-based guidelines. They do the severe TBI guidelines. They've taken this on. We have a terrific task force. We've already had 3 meetings, and they're on board. They are signed into this process, and so we're going ahead. We're looking at all the evidence. There's about--so far about 4,000 articles that we're sifting through, abstracting, and then really creating a map of what concussion looks like, and from that map, associations and a definition will come out of that. We don't believe that this is going to be a static definition. It's going to be changing based on evidence. It's going to have not only a definition but prognostic ability in it. Once you collect these parameters and you look at associations, obviously, you can look at associations for persistence of symptoms. So, this is the project that we're working on right now.
Posted on BrainLine February 2, 2012.
Produced by Noel Gunther and Justin Rhodes, BrainLine.
Jamshid Ghajar, MD, PhD is chief of Neurosurgery at Jamaica Hospital-Cornell Trauma Center, clinical professor of Neurosurgery at Weill Cornell Medical College and president of the Brain Trauma Foundation.