The Rise of Mild Brain Injuries
Market Insight 12 October 2023 12 October 2023
Claims involving a mild traumatic brain injury appear to be on the rise.
Earlier this year (25 April 2023), The Times published an article commenting upon a recent study which demonstrated that some people who had suffered even mild ‘knocks’ to the head could have acquired a brain injury, causing some long-term issues for those people. This, in turn, often resulted in a claim for compensation where the injury had been caused because of an avoidable accident.
Such minor head injuries can often be caused by a variety of activities, from simple falls at the home, to playing rugby, being involved in road traffic accidents, or simple DIY projects gone wrong.
The Times pointed to a study by Cambridge University, published by lead author Dr Emmanuel Stamatakis in the August 2023 issue of ‘Brain’ journal and on the University of Cambridge website on 26 April 2023, which states that around 47% of people of a study group of 108 patients with mild knocks to the head often suffered with symptoms for longer than 6 months, including depression, fatigue and headaches. In some cases, sufferers of such a knock or injury did not even receive treatment at hospital or at their local GP. Such cases, the study found, can be classed as a Mild Traumatic Brain Injury (‘mild TBI’) and can often go undiagnosed, or not picked up on until months or even years later, which of course causes issues for the people who have suffered such injury and the Insurers who are responsible for compensating those individuals.
The study, entitled ‘Acute thalamic connectivity precedes chronic post-concussive symptoms in mild traumatic brain injury’ stated that:
“We compared structural MRI and resting state functional MRI in 108 patients with a Glasgow Coma Scale (GCS) of 13–15 and normal CT, and 76 controls. We examined whether acute changes in thalamic functional connectivity were early markers for persistent symptoms and explored neurochemical associations of our findings using PET data. Of the mTBI [mild traumatic brain injury] cohort, 47% showed incomplete recovery 6 months post-injury. Despite the absence of structural changes, we found acute thalamic hyperconnectivity in mTBI, with specific vulnerabilities of individual thalamic nuclei.”
They concluded that the hope was that study of early ‘thalamic pathophysiology’ (essentially noting an abundance of activity in the thalamus region of the brain to overcompensate for any potential damage) can help identify cases where chronic symptoms are likely to arise in sufferers of a mild TBI and that new therapies and medicinal application might be developed to help combat those symptoms.
What about the long-term effects upon mortality of a mild TBI?
A study by the Department of Neurology at the Hospital of the University of Pennsylvania titled ‘Head Injury and Long-term Mortality Risk in Community-Dwelling Adults’, by Holly Elser et al, was published in January 2023. The aim of the study was to review the long-term effects on mortality of even minor head injuries.
Of the sample group of 13,037 participants over a 30-year period from a median age of 54, only 18.4% had suffered head injury (2,042 people) and the vast majority of that percentage who suffered head injury (around 95%) were classified as suffering a ‘mild TBI’.
The study concluded that the vast majority of those who had suffered any form of head injury had a reduced mortality compared to the control group, with an increased ‘hazard ratio’ of 1.99. In layman’s terms, they had a measurably shorter lifespan, even in cases of mild injury.
Causation, Post-Concussive Syndrome and Functional Neurological Disorder
Of course, causation issues will always arise when attempting to identify a potential brain injury. The usual indicators of a brain injury commonly involve a review of ambulance records of a patient, which may include reference to the lowering of the Glasgow Coma Scale score from 15, or perhaps mention of a loss of consciousness, or post traumatic amnesia, or even a bump or contusion to the head.
The Mayo Head Injury Classification System denotes that a mild TBI may occur if there is one or more of:
- Loss of Consciousness;
- Post-Traumatic Amnesia; or
- Skull Fracture.
In the absence of any of these symptoms, then one or more symptoms of blurred vision, confusion, dizziness, seizure, headache, or nausea could, according to the Mayo system, indicate a possible brain injury.
There is also of course the potential diagnosis of Functional Neurological Disorder (FND), which can often arise when there are no traditional diagnostic indicators of a brain injury having been suffered, and yet the person is still exhibiting cognitive issues. A common indicator of a ‘functional’ component to an injury can be seen where the symptoms get worse over time, which will not happen where an organic injury has been sustained and/or identified.
Hence, given the above, there is ever increasing scope for a Claimant to plead a brain injury.
What does this mean for Insurers and how can they identify a potential traumatic brain injury?
It is important for Insurers to identify claims at an early stage that may contain reference to a bump/knock on the head, or even any reference to cuts or abrasions on the head or face as a result of an accident. An early application to secure the injured person’s medical records (particularly the ambulance records) can assist greatly in identifying such cases.
Early detection of these matters will allow compensators to react and position themselves accordingly – and take a collaborative approach with Claimants and their representative to fully investigate any such incident. If in doubt, early referral to internal technical teams and solicitors with experience in head injuries for a second opinion can often prove to be invaluable.
The hope is, as the Cambridge University study mentions, that early treatments can be developed to better assist those who have suffered a brain injury, however mild it may be.