Traumatic brain injury (TBI) is classified as follows:
- Grade 1 – Commotio cerebri (concussion; S06.0); in this case, no permanent damage is present
- Grade 2 – Contusio cerebri (cerebral contusion; S06.3); there is open or closed damage to the brain
- Grade 3 – Compressio cerebri (cerebral contusion; S06.2); open or closed damage to the brain is present
Classification of the severity of a traumatic brain injury.
| Traumatic brain injury (TBI) | Glasgow Coma Scale | Unconsciousness |
| Mild TBI | 13-15 points | up to 15 minutes |
| Moderately severe TBI | 9-12 points | up to one hour |
| Severe TBI | 3-8 points | > 1 hour |
World Federation of Neurosurgical Societies coma classification.
| Komagrad | Description |
| I | Unconsciousness without other neurologic disturbances |
| II | Unconsciousness with side signs, unilateral pupillary rigidity or hemiparesis (hemiplegia) |
| III | Unconsciousness with extensor synergisms (nonepileptic sudden extensor movements of the body muscles on the trunk and legs (on the arms, both extension and flexion possible) with increased muscle tone) |
| IV | Unconsciousness with pupillary rigidity bilaterally |
Glasgow Coma Scale (GCS) – scale for estimating a disorder of consciousness.
| Criterion | Score | |
| Eye opening | spontaneous | 4 |
| on request | 3 | |
| on pain stimulus | 2 | |
| no reaction | 1 | |
| Verbal communication | conversational, oriented | 5 |
| conversational, disoriented (confused) | 4 | |
| unconnected words | 3 | |
| unintelligible sounds | 2 | |
| no verbal reaction | 1 | |
| Motor response | Follows prompts | 6 |
| Targeted pain defense | 5 | |
| untargeted pain defense | 4 | |
| on pain stimulus flexion synergisms | 3 | |
| on pain stimulus stretching synergisms | 2 | |
| No response to pain stimulus | 1 |
Assessment
- Points are awarded for each category separately and then added together. The maximum score is 15, the minimum 3 points.
- If the score is 8 or less, a very severe brain dysfunction is assumed and the there is a risk of life-threatening respiratory disorders.
- Adults: with a GCS ≤ 8, securing the airway by endotracheal intubation (insertion of a tube (hollow probe) through the mouth or nose between the vocal folds of the larynx into the trachea) must be considered.Children: with a GCS < 9 or respiratory compromise (eg, midface fractures), securing the airway by endotracheal intubation must be considered.
TBI includes: