doctor reviewing mri scan

Helmets are clashing on football fields all over the country this fall, which means thoughts of concussion may be on your brain. Concussion – also known as mild traumatic brain injury (TBI) – is a sudden change in mental status after a mild head injury that may or may not be accompanied by a loss of consciousness. The risk of concussion is not limited to football players, however. The leading causes of TBI are falls, motor vehicle accidents, and being struck by or colliding with a stationary or moving object.1

Most cases of concussion are not severe enough to require hospitalization, so the prevalence and incidence of this injury are underreported. However, an estimated 1.7 million Americans sustain a TBI each year, of which approximately 75% are concussions or other forms of mild TBI.2 Approximately 1,365,000 of these individuals with TBI are treated in emergency rooms, 275,000 are hospitalized, and 52,000 of them die.2,3

What should healthcare providers do when a patient presents with a suspected concussion? According to the ACOEM Practice Guidelines,4 which are available exclusively on MDGuidelines, the provider should begin with thorough medical and work histories and a focused physical examination. Be sure to keep an eye out for any “red flags” that may indicate the possibility of potentially serious disorders, such as increased intracranial pressure or intracerebral hemorrhage. The recommended diagnostic studies for TBI are wide-ranging but typically start with imaging.

(In addition, you can check out the ACOEM treatment algorithms for TBI on MDGuidelines for a great overview of diagnosis and treatment flow, ranging from initial assessment of the acute injury all the way to rehabilitation and recovery.)

The prognosis for TBI patients is naturally correlated with the severity of the TBI event. Full recovery is expected after mild TBI within 1 to 3 months.4 There is far less certainty on outcomes after repeated TBI events, nearly all of which involve athletes. Such repetitive brain trauma may lead to the degenerative disease of chronic traumatic encephalopathy (CTE),5 although the high-quality studies conflict on whether individuals who experience multiple TBIs have worse prognoses.4 Here at MDGuidelines, we will continue to monitor the literature for the latest evidence and keep you informed of new developments. In the meantime, stay safe at work and on the field!



  1. Coronado VG, et al. Surveillance for Traumatic Brain Injury-Related Deaths–United States,
    1997-2007. Morbidity and Mortality Weekly Report 2011;60:1-32.
  2. Centers for Disease Control and Prevention. Traumatic Brain Injury in the United States: Fact Sheet.
  3. Faul M. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations
    and Deaths 2002-2006.
  4. Hegmann KT, et al., eds. ACOEM Traumatic Brain Injury Practice Guideline. ReedGroup, Ltd.,
  5. Concussion Legacy Foundation. “What Is CTE?”