New Diagnostic Criteria for Mild Traumatic Brain Injury: Medical-Legal Considerations

The new American Congress of Rehabilitation Medicine diagnostic criteria for mild traumatic brain injury (mTBI) were published in 2023. The criteria are designed to be used across clinical settings. This article discusses some medical-legal issues and implications relating to the use of the new ACRM diagnostic criteria. First, the new criteria differ from previously published definitions. Second, the criteria can be applied weeks, months, or years after an injury through a clinical interview and review of records. Third, when there is diagnostic uncertainty, and the "suspected" mTBI classification is used, this is not meant to convey a level of diagnostic certainty, from a medical-legal perspective. Fourth, the diagnostic process could be influenced by subjectivity or biases on the part of the person or the examiner. Finally, the new criteria are diagnostic, not prognostic. They are designed to determine whether a person sustained an mTBI, but they are not designed to determine if a person's health problems months or years after an injury are related to that injury.