My last blog concluded with the statement that amnesia and confusion are not the same thing. One does not have to be confused to be amnestic for an event. Why is this distinction important? Because amnesia, the presence and length of it is the single most important predictor of outcome post brain injury.
Virtually all of our current triage methods for brain injury diagnosis test only for confusion. “Do you know what you are doing right now” is the essence of the EMT evaluation, the ER diagnosis. A Glasgow Coma Scale evaluation with a concussed person, is only asking if someone knows where they are, who they are and what day it is. Can anyone imagine the amnestic NFL quarterback not being able to answer those questions? So the NFL quarterback gets a 15 Glasgow Coma Scale, what some marginal expert witnesses call a “perfect score”, even though after the game he will not remember the game.
Certainly not all concussions result in permanent disability. In the vast majority of those concussions the injured person gets better. In fact gets better very quickly, maybe even within minutes. But when you are talking about the vast majority of something that happens millions of times a year, the minority of that group, still adds up to a lot of disabled people.
It is the concussions where people continue to be symptomatic hours and days later that are to be taken seriously. But how are we to know the difference if we don’t design our care, our triage, our diagnosis for concussion or brain injury, around questions and tests that distinguish whether people have amnesia. Not one question on the Glasgow Coma Scale asks the injured person about events between the time of the injury and the present. This must change or we will continue to underdiagnose hundreds of thousands of people every year.
In our next blog, we will talk about ways to make the questions asked in the Emergency Room more specific for diagnosing amnesia, and thus brain injury.