TBI imaging, diffuse axonal injury and DTI: the records that decide severity

Traumatic brain injury is graded mild, moderate or severe. The grade drives the guideline that applies, the recovery curve an expert describes, the life care plan and how a jury hears the word "mild." It is assigned from 4 measures, all recorded in the acute chart, not the imaging suite.

• Glasgow Coma Scale (GCS). A 3 to 15 score from eye, verbal and motor responses.
• Loss of consciousness (LOC). Whether, and how long, the person was unconscious.
• Alteration of consciousness (AOC). Confusion or feeling dazed without full unconsciousness.
• Post-traumatic amnesia (PTA). The period after the injury the person cannot remember.

The VA/DoD guideline adds a fifth row for structural imaging. It is the only row where a mild injury and a severe injury can look the same: the table allows normal imaging in all 3 grades.

Source: VA/DoD Clinical Practice Guideline, Management and Rehabilitation of Post-Acute Mild TBI, version 3.0, 2021, table 1. Its footnote: a patient who meets criteria in more than 1 category is assigned the higher severity.

The highest category wins

That footnote is the plaintiff's most useful sentence in the table. A GCS of 15 on arrival does not make an injury mild if the chart documents 3 days of amnesia; under the table, that is moderate. The defense check runs the other way: does a "moderate" label rest on 1 criterion the records do not support, such as an amnesia estimate written weeks later from the patient's own account?

The Glasgow Coma Scale in the chart

The GCS was described in 1974 by Graham Teasdale and Bryan Jennett. Its developers publish the current structure and guidance at glasgowcomascale.org. Each component is scored on the best response observed:

The components add to a sum score from 3 to 15. The developers' guidance is specific about 1 trap that shows up in almost every trauma chart: when a component cannot be tested, it should be recorded as "NT" (not testable), not assigned a score of 1, and no total should be reported. A GCS of "3T" or "7T" on an intubated patient is an artifact of that problem. It means the verbal score was not testable. It does not mean the patient scored 1 on speech.

The guidance also lists factors that interfere with the assessment: sedation, paralysis, intubation, language barriers, hearing loss and orbital fractures. Alcohol and drugs are the other big confounder in the emergency department, and the ACRM criteria say a clinical sign counts only when it is not better explained by intoxication, pain, psychological trauma or other confounders.

Why both sides read the GCS twice

• Which score counts. VA/DoD uses the best available score in the first 24 hours; ACRM uses the score after 30 minutes. A 12 at the scene and a 15 at triage read differently under each rule, so the time of each score is evidence.
• Components or only a total. A 14 can be E4 V4 M6 (confused) or E3 V5 M6 (eyes open only to voice). Charts that record only the total lose that detail.
• Who scored it. Paramedics, triage nurses and physicians score it minutes apart. The developers report good agreement between observers in most studies, and lower agreement in moderate impairment, where most disputes sit.
• What else was in the blood. The defense will attribute a low verbal score to a charted blood alcohol level. The plaintiff's answer is a repeat score after it would have cleared, if anyone recorded 1.

For 30 years, a widely used definition of mild TBI was the 1993 ACRM definition, a 2-page statement in the Journal of Head Trauma Rehabilitation. In 2023 the ACRM published new diagnostic criteria, built from an evidence review and a 3-round Delphi vote. The final agreement rate among the panel was 90.7%. Expect both sides to use whichever version suits their records, and expect older expert reports to cite only the 1993 text.

How the 2023 criteria work

The criteria tie each element to a record. Criterion 2 signs include LOC, altered mental status such as slowed or inappropriate responses, and amnesia around the injury. Criterion 3 symptoms may be delayed a few hours but "nearly always appear less than 72 hours from injury," and can be shown by acute care documentation or an interview about the first days. Criterion 4 covers cognitive, balance and eye movement findings on an acute exam, and elevated blood biomarkers, and notes that most of those tests lose sensitivity over the first 72 hours.

The 2023 criteria help plaintiffs whose acute chart shows symptoms and a positive exam finding but no clear LOC. They help defendants through criterion 6, which makes confounders part of the diagnosis. A diagnosis that ignores a charted blood alcohol level or a painful neck injury is open to attack under the very criteria the plaintiff's expert may cite.

Every severity measure in chapter 1 decays fast. Confusion clears, amnesia is only measurable while it lasts, and the ACRM notes that most exam and lab findings lose sensitivity over the first 72 hours. So the records written in that window are the primary evidence, and their gaps are the battleground. An MRI 3 weeks later can show a lesion. It cannot show confusion at the scene.

The measures are spread across at least 6 sources: the 911 call and dispatch log, the police report, the EMS run sheet, ED triage and physician notes, nursing neuro checks, and the first follow-up visits. The EMS run sheet belongs to the ambulance agency, not the hospital, so a hospital request will not produce it. Nursing neuro checks sit in flowsheets that some chart exports leave out. Between them they hold the serial GCS readings that show change over time.

A worked hypothetical: 1 crash, 3 stories

The timeline below is a labeled hypothetical, built to show how a normal CT and a "mild" discharge can sit on top of records that support a more serious grade, and how the same records give the defense its best arguments.

How each side works this timeline

5 conflicts to look for in every acute chart

1. "Denies LOC" against a witnessed LOC. A patient with amnesia for the event cannot reliably deny LOC. Set both entries side by side with times and authors.
2. A total GCS without components. Look for the components in the EMS report or a nursing flowsheet for the same period.
3. Templated "neuro intact" text. Compare discharge templates with the free text the same clinician wrote.
4. Clock drift. EMS software, dispatch, the EHR and the scanner keep separate clocks. A 6-minute offset can move a GCS past the 30-minute mark.
5. Amnesia estimated later. PTA durations in expert reports often come from an interview months later. Trace each figure to its first appearance.

A noncontrast head CT is the emergency test for head trauma. It answers the first hour question: is there bleeding, swelling or a fracture that needs a neurosurgeon. It was never designed to prove the absence of a brain injury. The ACRM 2023 criteria say neuroimaging "is not necessary to diagnose mild TBI" and that its main clinical role is to rule out injuries that might need neurosurgical or other medical intervention.

What the ACR recommends, and when

The ACR Appropriateness Criteria for head trauma rate each imaging test by clinical scenario. For acute mild head trauma, the ACR splits patients by whether a clinical decision rule calls for imaging; its references include the Canadian CT Head Rule and the New Orleans Criteria.

Source: ACR Appropriateness Criteria, Head Trauma, rating tables for variants 1 to 7. The same tables rate functional MRI, SPECT brain perfusion and FDG-PET/CT "usually not appropriate" in each of those scenarios.

2 points carry weight in litigation. A normal ED CT and no early MRI is the expected pattern for acute mild head trauma, so a missing early MRI proves nothing by itself. And MRI becomes "usually appropriate" once a patient has unexplained cognitive or neurological deficits in the subacute or chronic phase, which is where most litigated mild TBI claims sit.

How often MRI finds what CT missed

Both sides cite this study. For plaintiffs it shows a normal CT does not mean a normal brain. For defendants it sets limits: trauma center patients, MRI at about 12 days rather than months later, and 73% of CT-negative patients still had a normal MRI.

The imaging modalities at a glance

Diffuse axonal injury (DAI) is damage to the brain's long nerve fibers, the axons, caused by rapid acceleration, deceleration or rotation of the head. Much of it is microscopic. When small blood vessels tear along with the axons, the injury leaves tiny bleeds, and those bleeds are what imaging can see. The Yuh study calls them foci of hemorrhagic axonal injury.

Conventional sequences miss many of them. Susceptibility-weighted imaging (SWI) is an MRI sequence built to pick up blood products. A 2006 review in Archives of Physical Medicine and Rehabilitation by Ashwal and colleagues describes SWI as "more sensitive in detecting hemorrhagic lesions seen with diffuse axonal injury (DAI) than conventional imaging," and reports that in children with TBI the number and volume of hemorrhagic DAI lesions correlated with neurologic disability and with impairments of intelligence, memory and attention.

Which MRI findings predicted a worse 3-month outcome

That is the strongest peer-reviewed support for the claim that early MRI findings in mild TBI mean something for outcome. It is also narrower than it is sometimes presented. The finding was 4 or more foci, not 1. The outcome was measured at 3 months, not years. And odds ratios describe groups; they do not tell an expert how a specific person with 2 microbleeds will do.

Questions to ask about any reported microbleed

• Was SWI or gradient echo run? If not, "no hemorrhage" means none visible on the sequences used.
• How many foci, and where? Yuh's threshold was 4 or more. "Scattered foci" without a count needs clarification.
• Is each focus trauma-related? ACRM criterion 5 counts only trauma-related abnormalities, and small foci of blood products can have other causes. The neuroradiologist should say why the pattern fits injury.
• Is there an earlier scan? A pre-injury MRI, even 1 done for headaches years before, is the best test of whether a finding is new.

Diffusion tensor imaging is an MRI technique that measures how water moves through brain tissue. In healthy white matter, water moves more easily along the fibers than across them. Software turns that into values per region, most often fractional anisotropy (FA), from 0 to 1. Lower FA is read as a sign of disrupted white matter. With a normal CT and a normal conventional MRI, a DTI report showing low FA is often the plaintiff's only imaging evidence, which is why it draws so many challenges.

The rule the challenge is brought under

"A witness who is qualified as an expert by knowledge, skill, experience, training, or education may testify in the form of an opinion or otherwise if the proponent demonstrates to the court that it is more likely than not that: (a) the expert's scientific, technical, or other specialized knowledge will help the trier of fact to understand the evidence or to determine a fact in issue; (b) the testimony is based on sufficient facts or data; (c) the testimony is the product of reliable principles and methods; and (d) the expert's opinion reflects a reliable application of the principles and methods to the facts of the case."

The 2023 amendment, adopted by the Supreme Court in April 2023, took effect on December 1, 2023. It made 2 changes. It spelled out that the proponent must show each requirement is met more likely than not, and it amended (d) to emphasize, in the committee note's words, that each expert opinion "must stay within the bounds of what can be concluded from a reliable application of the expert's basis and methodology." The note also says many courts had treated the sufficiency of an expert's basis and the application of the method as questions of weight for the jury, and calls those rulings "an incorrect application of Rules 702 and 104(a)." For DTI, that matters most at step (d), where group research meets 1 patient. A lab can use a reliable method in general and still apply it unreliably to 1 patient. State courts apply their own versions of the rule, and some still use a general acceptance test, so check the standard in your jurisdiction before building a challenge or a defense of 1.

The published critique

A widely cited critique is a 2011 article in the Journal of the American Academy of Psychiatry and the Law by Wortzel and colleagues, which anchored a review of the DTI literature to the Daubert factors. Its main points:

• "Alterations in white matter integrity are not specific to TBI." Other conditions can lower FA, so a low value does not by itself confirm a mild TBI.
• There is no large normative database for each make and model of scanner and each software version. Each institution builds its own, which makes interpreting a single patient's result against local norms "preliminary at best."
• Group-level findings, where mild TBI patients as a group differ from controls, are not validated at the single-patient level.
• The authors concluded that expert testimony on DTI findings "will seldom be appropriate" in mild TBI litigation.

The same article gives the plaintiff something too. On whether the technique can be tested, the authors wrote that DTI as applied to mild TBI "fares well." They said their analysis "does not dictate the admissibility of DTI evidence in any given instance," and that with experienced labs and clinically unambiguous mild TBI, DTI may add a quantifiable measure of white matter integrity, though in those cases, they added, it would be superfluous evidence for an otherwise well-established mild TBI. The article is 15 years old. Expect the plaintiff's expert to say the field has moved on, and the defense to answer with the current ACR and VA/DoD positions.

What the current guidelines say

• ACR. MRI with DTI is rated "usually not appropriate" in all 10 head trauma scenarios in the Appropriateness Criteria, including subacute or chronic head trauma with unexplained cognitive deficits.
• VA/DoD. Recommendation 4 of the 2021 guideline: "We suggest against using the following tests to establish the diagnosis of mild traumatic brain injury or direct the care of patients with symptoms attributed to mild traumatic brain injury: a. Neuroimaging b. Serum biomarkers c. Electroencephalogram." It is a weak recommendation. The discussion says mild TBI "continues to be a clinical diagnosis" and that the associations found between DTI and symptom severity or return to work were weak.

A decision path for a DTI report

Glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase-L1 (UCH-L1) are proteins found in brain cells, GFAP in glial cells and UCH-L1 in neurons. After a brain injury they appear in the blood. The FDA granted De Novo authorization to the first test that measures both, the Banyan Brain Trauma Indicator, under decision number DEN170045. When a GFAP or UCH-L1 result appears in an ED chart, both sides will read it.

What the FDA authorized it to do

The indication is narrow. The test uses serum drawn within 12 hours of a suspected head injury, in patients 18 and older with a GCS of 13 to 15, "along with other available clinical information." A negative result "is associated with the absence of acute intracranial lesions visualized on a head CT." In other words, it helps decide whether a CT is needed. It was not authorized to diagnose a concussion or to measure how bad a brain injury is.

The clinical study in 1 table

The FDA summary estimated that the test could avoid about one third of unnecessary CT scans. Its required labeling includes this limitation:

"A negative result is generally associated with the absence of acute intracranial lesions. An appropriate neuroimaging method is required for diagnosis of acute intracranial lesions."

Reading a biomarker result in a case file

ACRM 2023 counts "elevated blood biomarker(s) indicative of intracranial injury" as a criterion 4 finding. The evidence it cites: in 1 study, GFAP was detectable within 1 hour, peaked at about 20 hours and kept its accuracy beyond 72 hours, though it may track CT findings less well in older adults. The VA/DoD guideline's recommendation 4 suggests against serum biomarkers to establish a mild TBI diagnosis in the post-acute phase.

Imaging and biomarkers answer whether there was structural injury. Neuropsychological testing answers a different question: how the person thinks, remembers and processes information now, compared with norms or with their own earlier performance. In most mild TBI cases with normal imaging, the neuropsychologist's report is the main evidence of lasting deficits, and the defense's IME neuropsychologist is the main rebuttal.

Timing

The VA/DoD guideline's recommendation 6 suggests against comprehensive neuropsychological testing during the first 30 days after a mild TBI. A full battery done in the first weeks may be challenged as premature. Screening tests done in the ED or at a concussion clinic are a different thing, and they can supply the criterion 4 cognitive finding under ACRM 2023.

Validity testing is expected, not optional

Performance validity tests (PVTs) check whether a person's test scores reflect their true ability, for example whether they gave full effort. Symptom validity tests check whether symptom reports are credible. The American Academy of Clinical Neuropsychology updated its consensus statement on validity assessment in 2021, with 20 experts reaching agreement in January of that year. Its conclusion is direct:

"All clinical and forensic evaluations must proactively address the degree to which results of neuropsychological and psychological testing are valid."

This lines up with ACRM criterion 6, which says criterion 4 test findings must not be better explained by "factors influencing the validity of the symptom reporting or test results." A neuropsychology report in a TBI case that has no validity measures, or that reports failed validity measures and then interprets the scores anyway, is open to attack from both directions.

Getting the raw data

Many psychologists will release test materials and raw scores only to another psychologist, citing test security and their professional ethics obligations. Plan early for a psychologist-to-psychologist exchange or a protective order. A report without raw data is hard to test, and a request made late in discovery will be fought on those grounds.

Lawyers and nurse consultants rarely read the images. They read the report, and the report has a structure that tells you more than its impression line. The mock report below is a hypothetical, built from the fields every radiology report carries. The numbered notes say what to check in each.

Preliminary and final reads

Overnight emergency CTs are often read first by an on-call or remote radiologist, then finalized later. The 2 versions do not always match. The hypothetical below shows the kind of change that can move a case from "normal CT" to mild TBI "with neuroimaging evidence of structural intracranial injury" under ACRM 2023.

A TBI file suits AI medical record review in 1 way and not another. The severity fight lives in text: EMS narratives, triage notes, neuro checks and discharge templates spread across thousands of pages and 6 or more providers. A large language model (LLM) can read, sort and cite those entries faster than a person. But the imaging is pixels, the neuropsychology is raw data held by a psychologist, and every judgment about severity and cause belongs to an expert.

Where it fails

• Images and DTI numbers. A language model sees the report text. It cannot read an MRI, count microbleeds or judge an FA value. That is a neuroradiologist's job.
• OCR on EMS records. Run sheets are often scans or photos, with handwritten notes. Optical character recognition (OCR) can read "13" as "15," and a misread GCS changes the grade. Low-confidence pages need a human read.
• Templated text. "Neuro intact, GCS 15" can be carried forward by EHR templates or drafted by ambient scribe tools. Clinical natural language processing that trusts the text records an exam no one performed.
• Hallucination. Generative AI can state a fact no page supports, such as an undocumented PTA duration. Where 30 minutes and 24 hours are thresholds, 1 invented figure can decide the grade.

The fixes are the ones courts now expect. Ground every line in a retrieval-augmented, page-level citation so a person can check it in 1 click. Keep a human-in-the-loop reviewer who checks the cites before anything leaves the firm. Lawyers have been sanctioned under Rule 11 for filing briefs with fabricated AI-generated citations, and an invented clinical fact in an expert disclosure is the same failure in a different document.

What to ask a vendor before uploading a TBI file

For a wider look at AI document review tools for neuropsychologists and IME evaluators, see the comparison for neuropsychology IME work. For the imaging question on its own, see can AI read DICOM imaging, and for the court question, is AI accurate enough for court.

Copy these into your own forms. Adjust the legal basis line to your jurisdiction and to whether you are sending a HIPAA authorization, a subpoena or a discovery request. For the mechanics of each route, see how to get medical records for a lawsuit.

RE: [PATIENT NAME], DOB [DATE]
Date of injury: [DATE]   Dates of service requested: [DATE] to [DATE]
Legal basis: [HIPAA AUTHORIZATION / SUBPOENA / REQUEST FOR PRODUCTION]

Please produce the complete record, including:

SCENE AND TRANSPORT
[ ] 911 call audio and dispatch (CAD) event log with timestamps
[ ] EMS patient care report, all pages, including narrative,
    every Glasgow Coma Scale entry with components, and times
[ ] EMS cardiac monitor or device data, if retained

EMERGENCY AND TRAUMA CARE
[ ] ED triage note and triage flowsheet
[ ] ED physician and trauma team notes, including addenda
[ ] Nursing flowsheets and neuro checks (GCS, pupils,
    orientation) for the full stay
[ ] Laboratory results with collection and result times,
    including blood alcohol, drug screen, and any GFAP or
    UCH-L1 test (device name and reference cutoff)
[ ] Discharge instructions and discharge summary

IMAGING
[ ] Every radiology report version: preliminary, final and
    each addendum, with timestamps and reader names
[ ] Images in native DICOM format for every CT and MRI,
    all series, not screenshots or a viewer-only disc
[ ] For any DTI study: raw diffusion series, scanner make,
    model and software version, acquisition parameters,
    analysis software and version, region selection method,
    and a description of the normative comparison data
[ ] Any prior brain imaging on file for this patient

FOLLOW-UP
[ ] Urgent care, primary care and concussion clinic notes
    for the first 30 days, including symptom scales and
    any cognitive, balance or eye movement screening

Please produce electronic records in native electronic
format where available, and certify completeness.
[NAME] [FIRM] [CONTACT]

CASE: [NAME]        INJURY TIME: [DATE, HH:MM, SOURCE]
CLOCK OFFSETS NOTED: EMS [+/- MIN]  ED [+/- MIN]  CT [+/- MIN]

TIME | HOURS FROM INJURY | SOURCE, PAGE | AUTHOR ROLE |
GCS (E/V/M or NT) | LOC | CONFUSION / AOC | AMNESIA (PTA) |
SYMPTOMS | EXAM FINDING | CONFOUNDER NOTED | CONFLICT WITH |
GAP BEFORE NEXT ENTRY

SEVERITY CHECK (VA/DoD table: highest category met wins)
  Best GCS, first 24 hours: [  ]  at [TIME], page [  ]
  LOC duration: [  ]  source: [WITNESS / PATIENT / NONE]
  AOC duration: [  ]  source: [  ]
  PTA duration: [  ]  first documented: [DATE, PAGE]
  Imaging: CT [NORMAL/ABNORMAL, PAGE]  MRI [  ]  SWI run [Y/N]

ACRM 2023 CHECK
  Criterion 1 mechanism: [  ]
  Criterion 2 signs: [  ]
  Criterion 3 symptoms under 72 hours: [  ]
  Criterion 4 exam or lab findings: [  ]
  Criterion 5 imaging: [  ]
  Criterion 6 confounders to address: [  ]
  Mild qualifier removed? LOC over 30 min [ ] GCS under 13
  after 30 min [ ] PTA over 24 hours [ ]

Medrecords AI is medical chronology software. It works on the records you upload; it does not request or retrieve records from providers. On a TBI file it does 5 things:

• Builds a cited chronology that pulls every entry on consciousness, amnesia, GCS, imaging and symptom onset from the first days, then follows the injury through neurology and neuropsychology, with a citation on every line back to the source page. The worksheet in chapter 11 starts as a draft instead of a blank sheet.
• Suggests the date of injury as a key date, with the pages that support it, for a reviewer to confirm before it anchors the timeline.
• Flags missing records the file implies, such as an ED note that says "per EMS" with no run sheet in the production, or a report that mentions a prior MRI nobody produced. Each flag cites the line that implies it.
• Routes scanned run sheets and handwritten pages through OCR and flags low-confidence pages for a human read.
• Loads CT and MRI studies as DICOM in a browser viewer and places them on the timeline through imaging review, so your neuroradiologist can cite a slice like a page.

What it does not do: it does not read or interpret CT, MRI, SWI or DTI images, does not grade severity, does not decide causation or admissibility, and does not score a case. Flags are signals, not verdicts. It runs under SOC 2 and HIPAA with a signed BAA (see security and HIPAA). Self-Service bills 10 cents a deduplicated page, down to 5 cents at volume, duplicates free; Enterprise On-Prem is an annual license. More on the use case: traumatic brain injury record review. For what happens after severity is settled, see the companion guide on TBI causation and long-term impact.

Does a normal CT scan rule out a traumatic brain injury?

No. CT finds bleeding, swelling and fractures that may need treatment. The ACRM 2023 criteria say neuroimaging is not necessary to diagnose mild TBI. In 1 multicenter study, 27% of mild TBI patients with a normal CT had an abnormal MRI about 12 days later.

What GCS score counts as a mild TBI?

13 to 15. The VA/DoD guideline uses the best available score in the first 24 hours; the ACRM uses the score after 30 minutes. Moderate is 9 to 12 and severe is under 9. If another criterion, such as PTA, points to a higher grade, the higher grade applies.

What is diffuse axonal injury?

Damage to the brain's long nerve fibers from rapid acceleration, deceleration or rotation of the head. Much of it is microscopic, but tiny bleeds that come with it can show on MRI, especially on SWI.

Is DTI admissible to prove a mild TBI?

It depends on the court, the rule applied and the documentation behind the study. Critics point to non-specific findings, missing normative databases and group data applied to 1 person. Read the opinions in your jurisdiction.

What does a GFAP and UCH-L1 blood test show?

For the first FDA-cleared test, a negative result in an adult with GCS 13 to 15, drawn within 12 hours, is associated with no acute lesion on head CT. It helps decide whether a CT is needed. It does not diagnose concussion; fewer than 1 in 10 positive results in the FDA study had a CT lesion.

When should neuropsychological testing be done after a mild TBI?

The VA/DoD guideline suggests against comprehensive neuropsychological testing in the first 30 days. Any forensic evaluation should include validity testing; the AACN 2021 consensus says all clinical and forensic evaluations must address whether results are valid.

Can AI read a brain MRI or a DTI scan for a lawsuit?

Not for litigation. AI tools can open DICOM studies, place them on a timeline and cite what the radiology report says, but reading the images, counting microbleeds and judging DTI values are tasks for a neuroradiologist.

Can AI software find every GCS and loss of consciousness entry in a TBI file?

AI medical record review can pull those entries from EMS, ED and nursing records and cite each to its page. A person should check every cite, especially on scanned run sheets where OCR can misread a 13 as a 15.

Is it HIPAA compliant to upload brain injury records to an AI tool?

It can be, with a vendor that signs a business associate agreement, holds SOC 2, does not train on your data and controls access. Consumer chatbots without a BAA are the wrong place for a file with psychiatric and substance use history.

Can ChatGPT build a TBI medical chronology?

A general chatbot can summarize pasted text, but it gives no page citations and can invent a GCS or a duration. For a chronology an expert will rely on, use a tool that cites every line to its page, and check each cite.

Every figure, cutoff and criterion here was checked against the primary source in September 2026. Quotes are verbatim. The crash timeline, the MRI report and the CT report versions are hypothetical. No court opinion is cited because none was reviewed. Nothing here is legal or medical advice.

• VA/DoD Clinical Practice Guideline for the Management and Rehabilitation of Post-Acute Mild Traumatic Brain Injury, version 3.0, 2021: severity table 1 and its footnotes, recommendations 4 and 6 and their discussion.
• Silverberg ND, Iverson GL and colleagues, American Congress of Rehabilitation Medicine diagnostic criteria for mild traumatic brain injury, Arch Phys Med Rehabil 2023;104(8):1343 to 1355, read in the author version with its supplement, which reprints the 1993 ACRM definition (Kay and colleagues, J Head Trauma Rehabil 1993;8(3):86 to 87).
• FDA De Novo decision summary DEN170045, Banyan Brain Trauma Indicator: indications for use, clinical performance and labeling limitations.
• American College of Radiology Appropriateness Criteria, Head Trauma: rating tables for variants 1 to 10.
• Glasgow Coma Scale, official site: components, sum score, the NT rule for untestable components, interfering factors and reliability.
• Federal Rule of Evidence 702 and the 2023 committee note; Supreme Court order of April 24, 2023 setting the December 1, 2023 effective date.
• Yuh EL and colleagues, Magnetic resonance imaging improves 3-month outcome prediction in mild traumatic brain injury, Ann Neurol 2013;73(2):224 to 235.
• Wortzel HS and colleagues, Diffusion tensor imaging in mild traumatic brain injury litigation, J Am Acad Psychiatry Law 2011;39(4):511.
• Sweet JJ and colleagues, AACN 2021 consensus statement on validity assessment, The Clinical Neuropsychologist 2021.
• Ashwal S and colleagues, Susceptibility-weighted imaging and proton magnetic resonance spectroscopy in assessment of outcome after pediatric traumatic brain injury, Arch Phys Med Rehabil 2006.

Related guides: TBI causation and long-term impact, blunt force trauma medical records, eggshell plaintiff and pre-existing conditions, how to write a medical chronology. Related solutions: sports concussion and CTE record review, motor vehicle accident record review, personal injury defense, legal nurse consultants.