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A review of mild head trauma. Part II: Clinical implications
1Oregon Health Sciences University, USA.
Abstract:
In Binder et al. (1997) a metal-analytic review revealed a small effect size attributable to a history of mild head trauma (MHT). The results suggested a weak association between MHT and persistent neuropsychological deficits. In this paper, additional outcome data are summarized and the results are discussed. On a chronic basis, 7-8% of MHT patients remain symptomatic and 14% are disabled from work. Magnetic resonance studies of acutely injured persons may show lesions that are not detected in usual clinical practice. It is likely that the effects of these lesions dissipate with time, consistent with the neuropsychological data. The association between MHT and cognitive deficits, symptoms, and disability may not be casual; data suggest that MHT patients have more psychosocial problems prior to injury than do non-injured persons. The examiner of the MHT patient with chronic complaints must consider alternative medical and psychiatric explanations and perform a differential diagnosis. The possibility of a neurological basis for sustained neuropsychological problems cannot be completely dismissed. Presently, however, there is little evidence for neurological causation of most persisting complaints.
Insights
A history of mild head trauma (MHT) shows a weak link to lasting neuropsychological deficits. While some MHT patients remain symptomatic or disabled, neurological causes for most persistent complaints are unlikely.
Area of Science:
- Neuroscience
- Psychology
- Neurology
Background:
- A previous meta-analysis indicated a small effect size for mild head trauma (MHT) and persistent neuropsychological deficits.
- Chronic MHT can lead to persistent symptoms and work disability in a notable percentage of cases.
Purpose of the Study:
- To summarize additional outcome data on mild head trauma.
- To discuss the association between MHT and long-term neuropsychological deficits.
- To explore potential causes and differential diagnoses for persistent complaints after MHT.
Main Methods:
- Review and summarization of additional outcome data.
- Discussion of existing meta-analytic findings.
- Consideration of magnetic resonance imaging (MRI) findings in acute injuries.
Main Results:
- 7-8% of MHT patients remain symptomatic chronically, and 14% experience work disability.
- MRI may detect acute lesions missed in clinical practice, but their effects likely dissipate.
- Pre-injury psychosocial problems are more common in MHT patients, suggesting non-causal associations with MHT.
Conclusions:
- The association between MHT and chronic deficits may be confounded by pre-existing psychosocial factors.
- Differential diagnosis is crucial, considering alternative medical and psychiatric explanations for persistent complaints.
- While a neurological basis cannot be entirely excluded, evidence for it causing most long-term MHT-related complaints is currently limited.