Classification of Injury Severity

Injury severity has consistently proved to be a major determinant of the consequences of TBI (Oddy

1993). However, methods of classifying TBI severity vary and are often not well standardized. Classifications of TBI severity have been developed based on factors such as impairment of consciousness and length of posttraumatic amnesia (see Table 27-1). The most common measure of injury severity is the Glasgow Coma Scale (Teasdale and Jennett 1974; see Table 27-2). Studies using this scale as the measure of severity have found that the majority of TBIs can be classified as mild (Kraus 1995). For instance, the National Pediatric Trauma Registry (Lescohier and DiScala 1993) indicated that 76% of TBIs are mild, 10% moderate, and 13% severe. Most children with TBI, especially with moderate or severe injury, experience a period of posttraumatic amnesia characterized by disorientation, confusion, and memory loss. Investigators have developed standardized methods for measuring the presence and duration of amnesia, such as the Children's Orientation and Amnesia Test (Ewing-Cobbs et al. 1990). Scores on this test have been found to predict postinjury memory function up to 12 months after TBI (Ewing-Cobbs et al. 1990).

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