Traumatic Brain Injury:
Screening
Ohio Valley Center for Brain Injury Prevention and
Rehabilitation
Department of Physical Medicine and Rehabilitation
The Ohio State University
and
Brain Injury Association of Ohio
Supported in part by a grant from the US Department of
Health and Human Services, Health Resources and Services
Administration (HRSA)
Why Screen for TBI?
• TBI is usually not a visible disorder
• Some people may not know that they have
had a TBI
• Documentation of a history of TBI may not
be found in medical records
• The effects of a TBI can have a significant
impact on responsiveness to standard
services or treatment methods
It’s not enough to simply know whether
or not someone has had a TBI
Better to know lifetime history:
– how many, of what severity
– when they occurred (developmental & how
recent)
– what effect they had, or are having
OSU TBI Identification Method
• Structured interview designed to elicit lifetime
history of TBI.
• Avoids misunderstanding about what a TBI is
by eliciting. injuries, then determining if TBI
may have occurred.
• Provides richer information about history than
simple “yes/no” (e.g., number, severity, effects,
timing, etc.)
Administration Instructions
The following slides provide
instructions in the administration and
scoring of the OSU TBI-ID Short
Form.
T-B-I Screening
Trauma: an injury that includes a blow to the head, the
head having impact with another object (e.g., the
ground, a windshield) or substantial shaking without
impact.
Behavioral effect immediately: an altered state of
consciousness evident in confusion, impaired
memory for events around the injury, or loss of
consciousness.
Impact on everyday function: Following the injury,
new onset or exacerbation of symptoms (e.g.,
headaches, dizziness, fatigue,) or function (e.g.,
ADL’s, managing money, employment).
T-B-I Screening using the
OSU TBI-ID Short Form
Trauma
Step 1: Questions 1-5. The goal of this step is to help
the respondent recall injuries to the head or neck by
reminding them about hospital visits and probing for
common causes of TBI.
Do not be concerned about whether a TBI occurred,
only if it was possible.
Questions 1-5
1. Have you ever been hospitalized or treated in
an emergency room following an injury to your
head or neck? Think about any childhood
injuries you remember or were told about.
Answer: YES (notes: car crash age 17, broken
leg, hit head on windshield)
Questions 1-5
2. Have you ever injured your head or neck in any
other car accident or some other moving
vehicle accident? For example, have you ever
been in an accident involving a motorcycle or
ATV?
Answer: NO
Questions 1-5
3. Have you ever injured your head or neck
in a fall or by being hit by something? For
example, have you ever fallen from a horse,
fallen while rollerblading, fallen on ice or
been hit by something, like a rock? Have you
ever been injured playing sports or on the
playground?
Answer: YES, fell on ice.
Questions 1-5
4. Have you ever injured your head or neck in a
fight, from being hit by someone, or from
being shaken violently? Have you ever been
shot in the head?
Answer: YES, bar fights in his 20s and 2
recent assaults on the street
Questions 1-5
5. Have you ever been nearby when an explosion
or a blast occurred? If you served in the
military, think about any combat-related
incidents.
Answer: NO
Question 6
If any of questions 1-5 were answered YES, then proceed to
Question 6 for each injury that was mentioned:
• Were you knocked out or unconscious following
any of the injuries that you mentioned before (do
NOT include loss of consciousness due to overdose
or choking here, see question 7).
• If there was loss of consciousness, ask the person to
estimate how long
• If there was no loss of consciousness, ask the person
if he or she was dazed or confused, or had gap in
memory
Question 6
6. Were you knocked out or unconscious following any of the
injuries you mentioned before? Were you knocked out when
you:
• Were in the car crash at age 17, hitting your head on the
windshield and breaking your leg?
Answer: YES
How long were you knocked out?
Answer: 15 minutes (we already know he was 17)
Question 6
•
•
Were you knocked out when you fell on ice:
Answer: NO
Were you knocked out in any of the bar fights in your 20s?
Answer: YES, many of them (Proceed to 7B)
Do you recall any of the fights in detail?
Answer: NO, they are blurred together
Can you tell me the longest time period that you were knocked out?
Answer: 5 MINUTES (never longer than)
At what age did the fights start and end:
Answer: 20-30
Question 6
•
Were you knocked out when you were assaulted on the street
recently?
Answer: Not the first time, but YES for the 2nd assault.
How long were you knocked out?
Answer: ONE HOUR
How old were you at the time?
Answer: 67
Question 7
Have you ever lost consciousness
from a drug overdose or being
choked?
Impact on everyday function:
Step 3: eliminated from the short form.
Can be explored in clinical interview with a question
like: “After that injury at age ___ did you have any
problems caused by the injury that you didn’t have
before or that got worse due to the injury?”
For any problems identified, ask “Is that still a
problem now?”
Special Interviewing Issue:
Multiple Mild TBI’s
• Some people have had multiple, mild injuries in a
short period of time, due to a single cause
– They will have problems remembering the details of
those injuries, including how many
– It may be enough to know that there was a period like
this, when it was, and how severe the worst injury was
during this time
– Note that some people may have had more than one of
these periods in their life
– In terms of treatment, knowing the cause of these
injuries may be helpful
Scoring
# TBI-LOC (number of TBI’s with loss of consciousness from 6)
# TBI-LOC ≥ 30 (number of TBI’s with loss of consciousness ≥
30 minutes from 6)
age at first TBI-LOC (youngest age from 6)
TBI-LOC before age 15 (if youngest age from 6 < 15 then =1, if
≥ 15 then = 0)
Scoring (continued)
Worst Injury (1-5):
If responses to #1-5 are “no” classify as 1 “improbable TBI”.
If in response to #6 reports never being dazed or having memory lapses
classify as 1 “improbable TBI”.
If in response to #6 reports being dazed or having a memory lapse classify
as 2 “possible TBI”.
If in response to #6 loss of consciousness (LOC) does not exceed 30
minutes for any injury classify as 3 “mild TBI”.
If in response to #6 LOC for any one injury is between 30 minutes and 24
hours classify as 4 “moderate TBI”.
If in response to #6 LOC for any one injury exceeds 24 hours classify as 5
“severe TBI”.
# anoxic injuries (sum of incidents reported in #7)
Age at which an injury occurs may be an
important aspect of lifetime history of TBI
• Age at first injury with loss of consciousness demonstrated the largest
number and magnitude of relationships with current cognitive
performance and self-reported behavioral problems
• Symptoms experienced initially after injury, especially childhood
injuries, were found to be associated with adult impairments
• Results suggested a relationship between number of lifetime injuries and
childhood developmental and adult medical conditions
Number and Severity of Injuries
• Three scores focus on either a combination of
number and severity of injury, or severity of the
worst injury
• These scores have been found to be associated
with cognitive and behavioral difficulties.
Example Scoring
•
•
•
•
•
•
#TBI-LOC:
3
#TBI-LOC>=30: 1
Age at first TBI-LOC: 17
TBI-LOC before age 15: 0
Worst injury: 4
# anoxic injuries: 0
Interpretation of Scores
• The scores that Jack received indicate that there is
a high likelihood that he was exposed to multiple
TBIs in his lifetime. Exposure seemed to have
begun by late adolescence. The worst injury was
of moderate severity and was within the past year.
Interpretation of Scores
• The indicators of exposure to TBI discussed in the
previous slide suggest that it is likely that Jack is
experiencing cognitive and behavioral consequences
from his injuries. Some of the consequences may
have been present for some time, while others may
have occurred as a result of the most recent injury.
Some effects of previous injuries may have worsened
after the most recent injury.
Resources
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www.ohiovalley.org
www.tbinetwork.org
www.biaoh.org
www.biaa.org
www.brainline.org
www.cdc.gov
Thank you.
Jennifer Brello, M.Ed., CCC-SLP
Program Director
Ohio Valley Center for Brain Injury
Prevention and Rehabilitation
Brello.1@osu.edu