Problems diagnosing traumatic brain injury

Brain injuries in the United States are both common and potentially devastating. More than 50,000 people die each year from the effects of traumatic brain injury, and another 2.5 million visits are made by patients to hospital emergency rooms are related to TBI.

Neuroimaging techniques, particularly computed tomography or CT scans and magnetic resonance imaging (commonly referred to as MRI) can play important roles in diagnosing and treating patients who have suffered a brain injury.

The high cost associated with CT scans and MRIs is a factor that doctors take into consideration before ordering them for patients who have suffered brain trauma. Patients showing only minor head injuries might not be candidates for imaging, but it can be difficult to distinguish a minor injury to the head from one that is major. Furthermore, once the decision is made to use imaging, doctors must decide which type, CT scan or MRI, will offer the best results.

Deciding if a brain injury is major or minor has been aided by the establishment of specific criteria that doctors may use. These criteria include:

• The Glasgow Coma Scale, which uses a patient’s consciousness level measured on a predetermined scale to determine if imaging is required.
• The New Orleans Criteria holds that the presence of either a headache or vomiting would indicate the need to resort to a CT scan or MRI to diagnose the brain trauma.
• Amnesia as an indicator of the use of imaging depends on its duration. For example, amnesia lasting less than 30 minutes might be associated with a minor head injury, but longer periods could be evidence of a more serious traumatic brain injury.

The use of imaging does not ensure a correct diagnosis. CT scans have been shown to miss up to 20 percent of abnormal brain conditions that would have been picked up on an MRI. Using an MRI does not, however, guarantee against a misdiagnosis of injuries because its increased sensitivity could reveal changes in the brain that are associated with the normal aging process rather than being caused by a TBI.

A person who believes that he or she might be the victim of a misdiagnosis of a traumatic brain injury, or who believes that physician error associated with the misinterpretation of MRIs might have caused a worsened medical condition, should speak to an attorney.