[Expert assessment of craniocerebral trauma]

The officially appointed external expert needs a precise documentation of the initial clinical findings and the findings at follow-up of the patient with craniocerebral trauma. The next step in preparation of the expert report consists in a pathophysiological and a neurological examination, including CT scan and EEG repeated at intervals; a stable condition can be expected after 1-2 years. In the case of reversible closed head syndrome (brain concussion) the expert should certify a disability for about 6 months; a degree of 20% for over 3 months should not be certified unless there are massive vegetative signs and symptoms. Persisting damage should only be recognized if a substantial brain lesion is present. In cases of cerebral compression or open skull fracture with manifest damage to the substance of the brain the duration of unconsciousness must be taken into account. For children and young people up to 10 days' unconsciousness is not taken to imply later disability; after 10-20 days' unconsciousness such young people are considered fit for work or school to a qualified extent; a persistent defect must be expected to follow unconsciousness lasting over 20 days. Adults who are unconscious for up to 5 days can be expected to make a complete recovery, while a longer duration of coma and more advanced age are associated with a worse outcome. The degree of functional impairment is thus important in the expert's decision on the level of disability. A flow chart is presented for guidance in the preparation of expert reports.(ABSTRACT TRUNCATED AT 250 WORDS)