Strategies to avoid a missed diagnosis of co-occurring concussion in post-acute patients having a spinal cord injury

A missed diagnosis of a concussion after a spinal cord injury can have negative consequences for patients and skew research results. Clinicians should be aware of the possibility of a missed traumatic brain injury (TBI) diagnosis in patients with spinal cord injuries (SCI). The presence of acute trauma-related life-threatening issues and/or the need for sedation or intubation during acute care hospitalizations of SCI patients may result in a missed diagnosis of mild-moderate severity TBIs. The diagnosis of a concomitant concussion and particularly of a mild-moderate severity TBI, in a SCI patient is important for planning rehabilitation interventions, to maximize functional returns, and for the prevention, anticipation, and early treatment of possible related medical complications.

• 1
  The incidence of a dual diagnosis of SCI with a co-occurring TBI may approach 60–74% with certain risk factors such as a motor vehicle collision or a fall.
• 2
  Mild traumatic brain injury (MTBI), also known as a concussion, occurs most commonly in 64–73% of dual diagnosis cases.
• 3
  Factors that may lead to a missed diagnosis include the subtle neuropathology of mild TBI, focus on SCI management, failure to collect GCS scores, and symptom overlap.