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BIAA Adopts New TBI Definition – is this better?

Posted Feb 13 2011 12:00am
06-Feb-2011

The Brain Injury Association of America (BIAA) is pleased to announce its adoption of a new definition of traumatic brain injury (TBI). Based on the proposal of the Demographics and Clinical Assessment Working Group of the International and Interagency Initiative toward Common Data Elements for Research on Traumatic Brain Injury and Psychological Health, BIAA has adopted the following definition:

TBI is defined as an alteration in brain function, or other evidence of brain pathology, caused by an external force.

. . .

A position statement released from the working group reported that “A clear concise definition of Traumatic Brain Injury (TBI) is fundamental for reporting, comparison, and interpretation of studies on TBI. Changing epidemiology patterns, an increasing recognition of significance of mild TBI, and a better understanding of the subtler neurocognitive neuroaffective deficits that may result from these injuries, make this need even more critical.”

According to Dr. Gordon, “The new definition incorporates the emerging evidence that signs and symptoms of the injured brain may emerge over time.”

BIAA believes this updated definition will better capture the essence of the disease process and the many varying outcomes present in persons with TBI and will reflect more recent research conducted by experts across the country.

This new definition sounds like quite a departure from other definitions, like

The definition at Medscape :

Traumatic brain injury (TBI) is a nondegenerative, noncongenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or altered state of consciousness.

or how the Centers for Disease Control and Prevention (CDC) defines TBI :

“craniocerebral trauma associated with neurological or neuropsychological abnormalities, skull fracture, intracranial lesions or death”

or even how the Mayo Clinic defines it

Traumatic brain injury is damage to the brain as the result of an injury.

Traumatic brain injury usually results from a violent blow or jolt to the head that causes the brain to collide with the inside of the skull. An object penetrating the skull, such as a bullet or shattered piece of skull, also can cause traumatic brain injury.

Mild traumatic brain injury may cause temporary dysfunction of brain cells. More serious traumatic brain injury can result in bruising, torn tissues, bleeding and other physical damage to the brain that can result in long-term complications or death.

The BIAA definition: an alteration in brain function, or other evidence of brain pathology, caused by an external force seems much broader, and also more open to interpretation than the others. I suppose it’s a reflection of the times, when we’re realizing how little we know about the brain and we’re trying to make more room for learning. I think this redefinition is good, but it also leaves some unanswered questions:

  • What kind of alteration of brain function are they talking about? Does this mean that any change in brain function, however long or short, can qualify as TBI?
  • What qualifies as brain pathology? Who makes that call?

I understand the need for conciseness, but are we short-changing the complexity of the situation by striving for a shorter definition?

These changes might be helpful in expanding research approaches and opportunities, but what are the ramifications? Does this new definition mean that more people can be declared “brain injured” even if their situation doesn’t warrant a whole lot of concern? And are we just creating even more of a black cloud over the heads of everyday people who get clunked on the head, get woozy and absent-minded for a while, then spend a whole lot of time thinking they might be brain injured and are just going to degenerate and end up as vegetables or living out of their car and slipping farther and farther into madness in their later years?

I might be going over the top with this, but when people in positions of power and influence make calls that affect us all, I feel like someone needs to ask these questions.

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