What is traumatic brain injury? TBI is a common injury which is easily missed when the trauma team is focused on saving an individual’s life. The effects of TBI are significant.
There are two categories of TBI: Mild and severe. Mild TBI is diagnosed as injury with loss of consciousness and/or confusion/disorientation which is shorter than 30 minutes. In mild TBI, a CT scan or MRI are often seen as normal while the individual has cognitive problems, headache, difficulty concentrating and thinking, memory problems, attention deficits, mood swings and frustration. Even mild TBI can be devastating to the injured person and their family.
Severe TBI is associated with loss of consciousness longer than 30 minutes and memory loss after the injury lasts longer than 24 hours. Deficits range from impairment of higher level cognitive functions to comatose states. Survivors may have limited function of extremities, abnormal speech, loss of ability to think or emotional problems. Survivors with severe injuries can be left in a long-term unresponsive state. Long-term rehabilitation may be required.
There are many injuries that can cause TBI. These are the mechanisms that are the highest causes: Open head injury, closed head injury, deceleration injuries, chemical/toxic, hypoxia, tumors, infections and stroke. Open head injury would be something like a gunshot wound that causes penetration of the skull. Closed head injury would be something like a slip and fall and vehicular accidents for example. Deceleration injuries is what is caused when the skull is moving fast and then suddenly stops, banging the brain against the skull. Shaken baby syndrome is another example.
Diffuse axonal shearing: when the brain is slammed back and forth inside the skull it is alternately compressed and stretched because of the gelatinous consistency. The long, fragile axons of the neurons (single nerve cells in the brain and spinal cord) are also compressed and stretched. If the impact is strong enough, axons can be stretched until they are torn. This is called axonal shearing. When this happens, the neuron dies. After a severe brain injury, there is massive axonal shearing and neuron death.
Chemical/toxic injury occurs when harmful chemicals damage the neurons. These chemical can include insecticides, solvents, carbon monoxide poisoning and lead poisoning. Hypoxia means lack of oxygen to the brain. This causes irreversible brain injury. Infections such as meningitis and encephalitis can cause TBI. Stroke is another mechanism of TBI, cell death can occur from lack of oxygen to the brain cells caused by the stroke.
If you practice personal injury cases, you may well have worked on these types of cases.
Plaintiff Attorneys should look for the following information:
- Was there failure to diagnose, failure to timely treat or transfer to a higher level of care?
- Did staff document and consider the mechanisms of injury?
- Was a head injury suspected?
- Were staff trained in the specific knowledge of trauma and follow the standard of care?
- Where did the injury occur?
- When did the injury occur? Timing is important; time from injury to first responder’s care.
- Was the treating facility a trauma center or a rural facility?
Defense Attorneys should look for the following:
- Were there any pre-existing conditions that could contribute to the head injury complications?
- Was there adequate staff in place?
- What else was going on in the ER at that time? Confusion due to a full house?
- If there were severe pre-existing conditions, was the patient compliant with his/her care?
- Does the patient share in the negligence in any way?
- Was there alcohol or illicit drug use involved?