Ascellus Blog

Concussions: The Price of Missing Signs of Brain Injury

October 10, 2022
Concussion diagnoses

In 2020, there were over 64,000 deaths related to traumatic brain injury (TBI) in the United States – that’s 176 deaths from TBI every day. Yet, it is estimated that up to 50% of all mild brain injuries go unreported. Signs of concussion are often not as immediately discernable as people believe, with loss of consciousness only occurring in 5-10% of cases. Often, older adults have a higher chance of suffering long-term consequences and even death from TBIs because mild symptoms of the injury often mimic those of other common ailments such as dementia. Undiagnosed and untreated concussions can lead to disability and even mental illness. It’s important to know the signs and to seek interventive treatment when needed to prevent the long-term repercussions of TBI from affecting life at home and at work. 

A TBI is an injury that can be caused by a bump, blow or jolt to the head, ultimately impacting brain function. A mild TBI is classified as a concussion while more acute injuries can be categorized as moderate to severe TBIs. While people often look for loss of consciousness or memory as a primary sign of head injury, other common symptoms include headache, nausea or vomiting, dizziness, sensitivity to light and sound, loss of energy, confusion or even a general sense of not “feeling right.” Symptoms usually appear immediately after injury; however, it is possible that indications of brain injury may not arise for hours or even days after the initial impact. 

Left untreated, a TBI can lead to trouble with balance, dizziness and vision. More drastically, nerve and brain stem damage from the injury can cause more concerning disabilities that impact the ability to live independently and work at full capacity. The psychological effects of the event are also worth noting and can be crippling if not considered in a comprehensive treatment plan. In fact, a National Institutes of Health study revealed that one in five adults may experience symptoms of mental illness within six months of sustaining a head injury.  

Researchers evaluated the mental health of 1,155 people diagnosed with mild TBIs over a one-year period with participants completing mental health questionnaires at three, six and 12 months post-injury. Compared to a control group that sustained orthopedic injuries without TBIs, 20% of participants reported symptoms of PTSD three months after injury compared to 8.7% of orthopedic patients. Mental health symptom reporting grew to 21.2% at six months while orthopedic patient reporting was 12.1%. 

Cognitive behavioral therapy has been shown to be effective for treating post-concussive symptoms such as PTSD, general depression and anxiety. In the Ascellus study, “Improving Outcomes for Work-Related Concussions: A Mental Health Screening and Brief Therapy Model,” researchers studied 157 patients who were experiencing delayed recovery due to work-related concussions (averaging 10 months off duty from work between the injury and the time of referral for the study). The study group was given a brief neurocognitive screening evaluation followed by a brief therapy model called work-related cognitive behavioral therapy. These patients showed significant improvement in return-to-work outcomes.

After an average of just eight sessions in eight weeks, an overwhelming 99% returned to full-duty work without restrictions or accommodations. Comprehensive diagnosis and treatment of TBIs with consideration for mental trauma associated with the injury can help patients recover quickly, so they can return to living and working without restriction. 

For more information on individual support and treatment interventions or organization-wide prevention programs, call us at 1.866.678.2924 or email us at

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Ascellus bridges the gap between mental and physical health to accelerate recovery for our nation's workforce. By connecting the workers' compensation industry with our expert behavioral care and evidence-based treatments, we deliver high-quality outcomes, helping injured workers reemerge with increased strength, purpose and resilience in the workplace.