invalidated on review, for example, attributable to intoxication, sedation, or systemic shock), and the presence of one or more of intracerebral hematoma, subdural hematoma, epidural hematoma, cerebral contusion, hemorrhagic contusion, penetrating TBI (dura penetrated), subarachnoid hemorrhage, and brainstem injury.

Mild (probable) TBI includes patients without any criteria of moderate-severe (definite) TBI and with one or more of LOC momentary to less than 30 minutes, posttraumatic anterograde amnesia of momentary to less than 24 hours, and depressed, basilar, or linear skull fracture (dura intact).

Symptomatic (possible) TBI includes patients without any criteria of moderate-severe (definite) and mild (probable) TBI and with one or more of blurred vision, confusion (mental-state changes), daze, dizziness, focal neurologic symptoms, headache, and nausea.

Comparisons with traditional single-measure systems (such as LOC or PTA) and approximate calculations of sensitivity and specificity have indicated that the Mayo system classifies TBI severity with reasonable accuracy (Malec et al., 2007).

The Brief Traumatic Brain Injury Screen

The Brief Traumatic Brain Injury Screen (BTBIS) is a one-page paper-and-pencil questionnaire designed by the Defense and Veterans Brain Injury Center (DVBIC) to screen for TBI in soldiers (DVBIC, 2007; Schwab et al., 2007) (Figure 2.7). It begins with a few questions about basic demographics and deployment history over the preceding 2 years, which are followed by three questions designed to identify possible TBI. The first of those, question S3, inquires about any injuries received during deployment with checkboxes indicating blast, vehicular, bullet, falls, and “other” as categories of injuries. Question S4 asks about neurologic features of TBI, including alterations in consciousness and LOC that resulted from injuries identified by the previous question. Question S4 also includes the categories “having symptoms of concussion afterward” and “head injury,” which are not part of the definition of TBI; those were included to provide further description of the injury for clinicians. Finally, question S5 aims at identifying specific symptoms and problems that are thought to be possibly associated with a head injury or concussion. Generally, it takes about 3–4 minutes to complete the BTBIS.

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