Content » Vol 46, Issue 1

Letter to the Editor

Does the mild traumatic brain injury (mTBI) research need to be internationalized right now?

We had hoped that the publication of our comments on the possible detrimental effect on rehabilitation of overlooking apparently insignificant, mild traumatic brain injuries (mTBI) (1, 2) last year, would dispel the recycling of advice regarding the need for follow-up visits. We advised that patients with craniofacial fractures should be examined by a clinician specialized in a field related to neuroscience. In another publication (3), we proposed detailed neurological check-ups for patients at risk, especially those who participate in certain sports. Meticulous assessment is imperative, especially in conditions such as those described by Carlsson & Af Geijerstam (4), where specimen (Swedish model) in-hospital stay is maximally reduced.

One intriguing idea is to promote international and multidisciplinary collaboration in traumatic brain injury (TBI) research (5). Traditional lack of collaboration disallows the promotion of international and multidisciplinary collaboration. However, collaboration depends on agreement about an unambiguous, single definition of mTBI, which, at times, is regarded as “concussion.” Thus, it is perhaps rather academic at this stage to advocate careful follow-up over time and possibly to distress patients and professionals with the entire spectrum of long-term sequelae of unnoticed mTBI. In addition, there is no current research into determining a multidisciplinary view. However, is this not merely an example of reinventing the wheel?

Calls to abandon the path of reductionism, to take a broader view, and to update the classification and characterization of multidimensionality could all be silenced by the argument that these ideas have already all been put forward. After all, such thinking was the incentive for the development of the International Classification of Functioning, Disability and Health. Have we heard enough of these arguments? Articles repeating the same conclusions are just a subtle way of announcing that need to the wider masses. Or, are they highlighting the need for a Core Set?


Accepted Nov 1, 2013; Epub ahead of print Nov 21, 2014

Darko Ledic, MD, PhD1* and Ivan Sosa, MD2*

From the 1Department of Neurosurgery and 2Department of Forensic Medicine and Criminalistics, Rijeka University School of Medicine, Rijeka, Croatia. E-mail: *Both authors contributed equally to this paper.

1. Sosa I, Grubesic A, Bosnar A. Mild traumatic brain injuries and their sequelae. I: the need for screening. J Rehabil Med 2012; 44: 988.

Stalnacke BM, Nygren-Deboussard C, Godbolt A, Af Geijerstam JL, Holm L, Borg J. Mild traumatic brain injuries and their sequelae. II: at risk of clinical neglect? J Rehabil Med 2012; 44: 989–990.

3. Sosa I, Linic IS, Petaros A, Desnica A, Bosnar A. The potential value of early screening for neurological deficits in participants in certain sports. Med Hypotheses 2011; 77: 633–637.

Carlsson S, Af Geijerstam JL. Management of mild traumatic brain injuries in emergency departments in Sweden: Evidence of a change in clinical practice. J Rehabil Med 2013; 45: 718–720.

5. Manley GT, Maas AI. Traumatic brain injury: an international knowledge-based approach. JAMA 2013; 310: 473–474.