Evaluation of Traumatic Brain Injury Cases: The Plaintiff’s

Perspective

By Charles G. Monnett III

Vocabularies plaintiff /'plent f/ɪ a person who makes a formal

complaint against somebody in a court of law 原告；起訴人

traumatic  /trau'mæt k/ɪ connected with or caused by trauma 創傷的；外傷的；損傷的

litigation / l t 'ge n/ˈ ɪ ə ʃə the process of making or defending a claim in a court of law 訴訟；打官司

prognosis /pr g'nos s/ɑ ɪ an opinion, based on medical experience, of the likely development of a disease or an illness （對病情的）預斷，預後

concussive [k n k s v] ə ˈ ʌ ɪ 給與衝擊的 震盪性的 Post-concussive syndrome: 腦震盪後綜合症

sequela [s kwil ] ɪˈ ə 【醫】後遺症 , 後發症 ；結果 nausea /'n s /ɔ ɪə the feeling that you have when

you want to vomit, for example because you are ill/sick or are disgusted by something 惡心；作嘔；反胃

tinnitus /'t n t s/ɪ ə ə an unpleasant condition in which somebody hears ringing in their ears 耳鳴

seizure /'si /ʒɚ a sudden attack of an illness, especially one that affects the brain （疾病，尤指腦病的）侵襲，發作

spasticity痙攣 insomnia / n's mn /ɪ ɑ ɪə the condition of being

unable to sleep 失眠（症） agitation / æd 'te n/ˈ ʒə ʃə worry and anxiety that

you show by behaving in a nervous way 焦慮不安；憂慮；煩亂

Some Technical Terms…

MRI: Magnetic Resonance Imaging 磁共振造影

CT: Computed tomography 電腦斷層掃描 EEG: Electroencephalography 腦電圖 PET: Positron emission tomography 正電子

發射計算機斷層掃描 SPECT: Single photon emission computed

tomography 單光子放射電腦斷層造影

Main Idea

Because the effects of TBI are unique to the injured individual, it is difficult to compare cases or make generalized assessments about the value of types of TBI claims, making the evaluation of a claim involving mild traumatic brain injury a challenging task for attorneys. Each case will require careful consideration of factors that may affect the ultimate outcome.

Supporting Information

Post-concussive syndrome for patients with mild TBI includes physical, cognitive and emotional symptoms which vary greatly for each patient. Physical? Cognitive? Emotional?

→ No typical pattern showing how the patient is influenced by TBI

Many factors affect the value of each TBI case. Careful consideration of factors is required.

One of the factors: Documented injury In most mild TBI cases, diagnostic tests will be

completely normal. No consistency between the diagnostic tests

and the neuropsychological evaluation → Hard to convince the insurer or jury that the Plaintiff has impaired mental functions

Conclusion

No typical pattern Unique cases Difficult to compare Difficult to value TBI claims Each case needs consideration on different

factors

Glasgow Coma Scale level of consciousness after head injury

Glasgow Coma Scale

1 2 3 4 5 6

EyesDoes not

open eyes

Opens eyes

in response to

painful stimuli

Opens eyes

in response to

voice

Opens eyes

spontaneouslyN/A N/A

VerbalMakes no

sounds

Incomprehe

nsible sounds

Utters

inappropriate

words

Confused,

disoriented

Oriented,

converses

normally

N/A

MotorMakes no

movements

Extension to

painful stimuli

(

decerebrate re

sponse

)

Abnormal

flexion to

painful stimuli

(

decorticate res

ponse

)

Flexion /

Withdrawal to

painful stimuli

Localizes

painful stimuli

Obeys

commands

Glasgow Coma Scale

the score is expressed in the form "GCS 9 = E2 V4 M3 at 07:35“ The lowest possible GCS (the sum) is 3 (dee

p coma or death), while the highest is 15 (fully awake person)

Generally, brain injury is classified as: Severe, with GCS ≤ 8 Moderate, GCS 9 - 12 Minor/Mild, GCS ≥ 13.

Discussion

Do you think it is proper to compensate plaintiff with acquired brain injury that haven’t diagnosed?

If you are the judge, will you adopt these general classifications of brain injury which provide indication of patient’s ultimate prognosis? Why?

In the article, it mentioned one of the factors that affect the value of a TBI case—documented injury. Can you think of some other influential factors?

Do you think it is possible to classify TBI not only into 3 categories(severe, moderate, mild) but into more subcategories so as to provide easier ways to value TBI claims? Why or why not?