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Comment & Response
December 30, 2019

The Term Traumatic in Mild Traumatic Brain Injury and the Misrepresentation of Outcomes

Author Affiliations
  • 1Northwestern University Feinberg School of Medicine, Chicago, Illinois
JAMA Neurol. 2020;77(2):264. doi:10.1001/jamaneurol.2019.4454

To the Editor Nelson et al1 state that the term mild in mild traumatic brain injury misrepresents the burden of traumatic brain injury. Seminal prospective controlled studies by 3 of Nelson’s own coauthors, who are neuropsychologists, that date back to the 1980s contradict the findings of this article.1 To my knowledge, Levin et al2 were the first to conclusively show that a single uncomplicated mild head injury produces no permanent neurobehavioral impairment. A Glasgow Coma Scale score of 13 to 15 and a coma not to exceed 20 minutes was introduced earlier as a definition of mild head injury.3 Levin et al2 added normal imaging as the third defining feature to separate those with complicated mild head injury, namely acute imaging abnormalities. An earlier study3 that included patients with mild complicated injury showed cognitive and functional impairment. Dikmen et al4 published the second important article. One year post–head injury, patients who took up to an hour to follow commands did not differ cognitively from the controls. Curiously, neither of these 2 articles are cited by Nelson et al.1 The benign outcome of mild head injury seen in the civilian literature was established by McCrea et al5 in the best-characterized sports concussion sample published at that time. The cognitive effects of concussion resolve in 7 days.5

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