Talk:Traumatic brain injury/GA1

GA Review
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In the lead section, paragraph 2: "TBI is a major cause of death and disability worldwide and the leading killer of people under age 45". I see that is later referenced to Dolce: "Post-traumatic vegetative state". Is this really true worldwide? I thought that the leading killer in that age group was infectious disease? Axl ¤  [Talk]  20:05, 31 October 2008 (UTC)
 * I've seen this figure cited all over the place. That source says, "Traumatic brain injury is the primary cause of death in the first 45 years of life.  Mortality during the early post-traumatic phase has been significantly reduced in developed countries..." (p. vii)  This juxtaposition with 'developed countries' suggests to me that they're not writing about the US like it's the only place in the world (the way a lot of authors unfortunately do).  I can probably find a source that explicitly says 'worldwide' if that's really the case, though.  If I had to guess about the infectious disease question, I'd say the causes probably vary based on what the criteria are used in the epidemiological studies.   delldot   &nabla;.  06:23, 1 November 2008 (UTC)
 * Crap, the under 45 statistic is from the US. Sorry about that, removed. However, I found a source for "Traumatic injury remains the leading worldwide cause of death and a major cause of disability in children." So that I kept.   delldot   &nabla;.  06:49, 1 November 2008 (UTC)
 * I'm still not convinced. I'll have to dig out that Lancet paper later. Another WHO link. Axl  ¤  [Talk]  12:24, 1 November 2008 (UTC)
 * Actually, looking at that again I realize it's not clear whether that quote means "of death (in children) and ... disability in children" (as I had assumed) or if these are stats for two different groups (in which case it's even less likely to be true). Also I notice now they said traumatic injury rather than TBI, so that was a big blunder on my part! Glad you caught it.  Removed now.   delldot   &nabla;.  18:42, 1 November 2008 (UTC)

From "Classification", paragraph 1: "All traumatic brain injuries are head injuries, but head injury is not necessarily brain injury: it may involve structures within the skull and outside of it such as the face or jaw". This point seems unnecessarily laboured. Axl ¤  [Talk]  20:09, 31 October 2008 (UTC)
 * Shortened to All traumatic brain injuries are head injuries, but the latter term may also refer to injury to other parts of the head. delldot   &nabla;.  05:43, 1 November 2008 (UTC)
 * Thanks. Axl  ¤  [Talk]  12:19, 1 November 2008 (UTC)

From "Classification", paragraph 1: "However, the terms head injury and brain injury are used synonymously", referenced to Hannay: "Neuropathology for neuropsychologists". While this may be true for neuropsychologists who see patients in the post-acute setting when the injury has been formally imaged, diagnosed and treated, this is certainly not true in the emergency department. In the ED, people are often brought in unconscious with evidence of superficial injury to the head. However at the time of admission, the cause of unconsciousness may not necessarily be brain injury; alcohol/drug intoxication, hypoglycemia, convulsion, or any of a number of other reasons may cause unconsciousness. Hence "head injury" does not necessarily imply "brain injury". Axl ¤  [Talk]  20:18, 31 October 2008 (UTC)
 * Can I get away with  may be used synonymously? Or should I go into detail about the situations where the terms are used?  I could add something like "before diagnosis" but I haven't so far.   delldot   &nabla;.  05:43, 1 November 2008 (UTC)
 * How about "are sometimes used synonymously"? Axl  ¤  [Talk]  12:19, 1 November 2008 (UTC)

The CT image in "Classification", "Focal vs. diffuse" shows a left parietal subdural hematoma. Is it possible to add an arrow to point it out? Axl ¤  [Talk]  20:28, 31 October 2008 (UTC)
 * Not a problem for me to do, but the hematoma is awfully big, maybe a series of arrows? Or just a reference in the caption like "seen on the right side"?  delldot   &nabla;.  05:43, 1 November 2008 (UTC)
 * I think that a single arrow would be enough. I'm reluctant to say "seen on the right side", because the hematoma is left-sided. Still, I don't have a strong opinion about this, and I won't withhold GA status regardless of whether you leave the image as it is or change it slightly. Axl  ¤  [Talk]  12:31, 1 November 2008 (UTC)

From "Signs and symptoms", paragraph 1: "Unconsciousness tends to last longer for people with injuries are on the left side of the brain than for those with injuries on the right". Wow, I didn't know that. You should submit it to WP:DYK. Axl ¤  [Talk]  20:38, 31 October 2008 (UTC)

In "Causes", I presume that the 19% "struck by an object" (yellow in the pie chart) refers to accidental injuries (because assault constitutes a further 11%)? Axl ¤  [Talk]  20:48, 31 October 2008 (UTC)
 * I'm afraid this has more to do with how it was written up in the patients' charts reviewed in the original studies--that's one problem with these types of studies, often there's not a lot of info to work with. But yeah, I assume the researchers did their best to separate violence and accidental injuries and at the very least didn't put people in more than one category each.  delldot   &nabla;.  05:43, 1 November 2008 (UTC)
 * Okay. Let's leave it as it stands. Axl  ¤  [Talk]  12:47, 1 November 2008 (UTC)

"Causes", "Sports" strikes me as US-centric sports trivia. Still, I don't have a strong objection to it. Axl ¤  [Talk]  20:52, 31 October 2008 (UTC)
 * Yeah, a new user added that really recently. Not a good reference either.  My preference would be to take it out, but I didn't want to bite. I think it would be best if sports were mentioned as one or two sentences in with the rest of the causes section, especially given that it's not the biggest cause.  Maybe I'll leave them another note.   delldot   &nabla;.  05:43, 1 November 2008 (UTC)
 * Okay. Axl  ¤  [Talk]  12:38, 1 November 2008 (UTC)

In "Complications", "Emotional and behavioral problems", paragraph 1: "Problems that may persist for one half year to two years after the injury may include...". I'm not sure what the lower time limit is. Axl ¤  [Talk]  21:58, 31 October 2008 (UTC)
 * Now that you mention it, yeah, that doesn't make any sense. Obviously they can last less than that too.  Maybe the authors of the source were listing different opinions about the maximum length.  At any rate, changed to "up to two years".  delldot   &nabla;.  05:43, 1 November 2008 (UTC)
 * Thanks. Axl  ¤  [Talk]  12:38, 1 November 2008 (UTC)

In "Epidemiology", "Mortality": does the pie chart specifically refer to US mortality? Axl ¤  [Talk]  22:13, 31 October 2008 (UTC)
 * Yes, the reference cites a West Virginia study. I've tried to present a global view but it's difficult here because there's so much more info about the US available.  For example, that source says, "The role of TBI as a cause of death and disability in the United States [8] and in Canada [9] is well-documented" and then only gives the US data in that detail (whereas it presents a lot of info from various countries throughout the rest of the paper).  I can add other info about mortality in other countries, but I doubt I'll find a breakdown by causes like this.  Alternately I can take the chart out.  delldot   &nabla;.  06:23, 1 November 2008 (UTC)
 * Thanks for clarifying that. I initially suspected that the chart referred to US mortality because of the high number of "firearms" fatalities. Now the chart is fine. Axl  ¤  [Talk]  12:43, 1 November 2008 (UTC)

I've been thinking about spinning out a separate Complications of traumatic brain injury article and leaving a summary here for the massive complications section. What do you think? delldot  &nabla;.  06:23, 1 November 2008 (UTC)
 * Yes, a spinout article is a good idea. Axl  ¤  [Talk]  12:43, 1 November 2008 (UTC)

In other news, I think the expansion from abbreviations in the table makes it too wide and squishes the text next to it. What do you think about linking but with GCS, PTA, and LOC? Those abbreviations are used in the sentence in the text that references the table. delldot  &nabla;.  06:35, 1 November 2008 (UTC)
 * Yes, that would be fine. Axl  ¤  [Talk]  12:43, 1 November 2008 (UTC)

GA pass
Another fine article by Delldot. It is well-written, accurate, well-referenced, comprehensive, stable, neutral, and nicely-illustrated. I am delighted to assign "Good article" status.

Points for further improvement:-
 * From "Complications", "Emotional and behavioral problems": "About 9% [of people with TBI] suffer mania", referenced to Rao, "Neuropsychiatric sequelae of traumatic brain injury". This seems like a rather high proportion of serious psychotic illness from a large group including relatively minor injuries such as concussion. Perhaps Delldot could review this reference?
 * From "Causes", please consider reducing the "Sports" section.
 * Consider developing a "History" section.

Thanks. Axl ¤  [Talk]  12:59, 1 November 2008 (UTC)
 * Thanks much Axl!  delldot   &nabla;.  18:42, 1 November 2008 (UTC)