TBI

Mild TBI Screening Inventory | Center for Cognition & Compassion

1Setup

2Mechanism

3Pathways

4Severity

5Results

Welcome — Let's Get Started

This Mild TBI Screening Inventory walks through the six-criterion decision process from the 2023 ACRM diagnostic criteria for mild traumatic brain injury, developed by Silverberg, Iverson, and colleagues. It is intended to support clinical education and structured review. It takes approximately 3–5 minutes to complete.

✓ Criterion 1 — Mechanism of Injury
✓ Criterion 2 — Clinical Signs (Pathway A)
✓ Criteria 3 + 4 — Symptoms + Objective Findings (Pathway B)
✓ Criterion 5 — Neuroimaging Evidence (Pathway C)
✓ Criterion 6 — Confounding Factors
✓ "Mild" Severity Qualifier

Terms of Use & Disclaimer

Educational Use. Prohibted Use — Key Points

Legal proceedings — results may not be cited, introduced, or reproduced in any court, deposition, or hearing
Witness or client coaching — may not be used to prepare any person before a clinical evaluation, IME, or legal proceeding
Insurance & disability claims — may not be used in any insurance, workers' compensation, or disability proceeding
Strategic symptom framing — may not be used by any party to emphasize or minimize symptoms for adversarial purposes
Misrepresentation — may not be described as a validated clinical instrument, standardized assessment, or professional evaluation

Full terms — scroll to read

Educational purpose. This inventory is provided for educational and informational purposes only. It is based on the 2023 American Congress of Rehabilitation Medicine (ACRM) diagnostic criteria for mild traumatic brain injury (Silverberg, Iverson et al., Archives of Physical Medicine and Rehabilitation, 104(8):1343–1355, doi: 10.1016/j.apmr.2023.03.036) and is intended solely to support clinical learning, structured review, and professional training discussions.

Not a clinical instrument. This tool has not undergone formal psychometric study, normative development, standardization, or peer review as a standalone assessment. It may not be represented to any person or entity as a clinical test, validated screen, standardized instrument, or professional assessment of any kind. The 2023 ACRM criteria reflected here are classification criteria only — they are not prognostic and do not predict recovery, symptom duration, functional outcome, or injury severity beyond the mild/non-mild distinction.

No professional relationship. This inventory does not replace medical, psychological, neuropsychological, or behavioral health services. Use of this tool does not create a patient–provider, doctor–patient, or therapist–client relationship with the developer, the Center for Cognition & Compassion, or any affiliated personnel. Responses and results are intended to support self-reflection and clinical discussion only and should be reviewed with a qualified healthcare professional.

Prohibited uses — full detail. The following uses are expressly prohibited: (1) introduction, citation, reproduction, or reliance upon results — in whole or in part — in any legal, administrative, or regulatory proceeding; (2) use to prepare, coach, orient, or inform any witness, claimant, plaintiff, or defendant prior to a clinical evaluation, neuropsychological examination, independent medical examination, deposition, or legal proceeding of any kind; (3) use by any party — including plaintiffs, defendants, insurers, or their representatives — to identify, emphasize, minimize, or strategically frame symptoms or findings for any legal, insurance, or adversarial purpose; (4) use in connection with any insurance claim, disability determination, workers' compensation proceeding, government benefit application, or any administrative process in which neurological injury is at issue; (5) describing or presenting this tool to any third party as a validated screen, clinical assessment, or professional evaluation; (6) reproduction of any portion of this tool — including its content, structure, criteria, screenshots, or generated results — in any legal or administrative proceeding; (7) automated, programmatic, or systematic use of any kind.

Notice to legal professionals & attorneys. This tool is based on peer-reviewed consensus criteria used by neuropsychologists, physiatrists, and neurologists in clinical and educational settings. It was developed exclusively for clinical education and professional training and is expressly not intended for use in legal proceedings, personal injury litigation, or any adversarial context. Use of this tool does not constitute and cannot be construed as a clinical opinion, expert opinion, or professional endorsement by the developer or the Center for Cognition & Compassion regarding any individual, claim, or case. The developer's creation of this tool reflects no clinical opinion regarding any specific individual, case, or claim and cannot be attributed to the developer as a professional opinion in any proceeding in which the developer has not been formally retained as an expert. The developer expressly disclaims any responsibility for use of this tool by attorneys, paralegals, claims adjusters, or any non-clinician for purposes related to litigation, case strategy, or witness preparation. Neuropsychological findings relevant to legal proceedings must be obtained through a formal evaluation conducted by a licensed neuropsychologist, documented in a professional report, and subject to applicable standards of professional practice and rules of evidence.

Privacy. All responses and results are generated and remain entirely within your local browser. No information is transmitted to, stored on, or accessible by any external server, database, or third party. No data leaves your device. No personally identifiable information is collected.

Emergency situations. This tool is not monitored and is not intended for use in emergency situations. If you or someone you know requires urgent medical attention following a head injury, contact emergency services immediately or go to the nearest emergency room.

Voluntary participation. By continuing, you acknowledge that participation is voluntary and that you have read, understood, and agree to all terms stated above, including all prohibited uses.

I have read and agree to the Terms of Use & Disclaimer. I understand this tool is for educational purposes only, that all prohibited uses listed above apply to me, and that use of this tool does not replace professional clinical evaluation.

Criteria 2, 3, 4, 5

Evidence of Acute Brain Disruption

Following a plausible mechanism, mild TBI requires meeting at least ONE of the three pathways below. Pathways are independent — satisfying any single pathway is sufficient.

Pathway A

Clinical Signs — Criterion 2

Observable or elicitable signs of acute brain disruption. These are objective, observable indicators — not subjective feelings. They must be witnessed, documented in records, or carefully reconstructed. Subjectively experienced feelings belong in Criterion 3.

Threshold: ONE or more clinical signs is sufficient for Pathway A.

i. Loss of Consciousness (LOC)

Loss of consciousness immediately following injury

Must be < 30 minutes to qualify as mild TBI. Observable signs: no protective action taken on falling, lying motionless and unresponsive. LOC ≥ 30 minutes places injury beyond "mild."

ii. Alteration of Mental Status (AMS)

Onset must be immediately following injury or upon regaining consciousness. GCS must be ≥ 13 at 30 minutes post-injury. These are observable signs — witnessed behavioral indicators, not subjective feelings. Subjectively experienced feelings of confusion or disorientation belong in Criterion 3, not here.

Observed reduced responsiveness — unresponsive or giving inappropriate responses to external stimuli immediately after injury

Must be witnessed, documented in acute care records, or reconstructed via the hypothetical approach. Not a subjective feeling.

Observed slowness to respond — noticeably delayed or slowed responses to questions or instructions immediately after injury

Must be observed by another person or reconstructed via hypothetical self-report. Not "feeling slow" — that is Criterion 3.

Observed agitated behavior — agitation witnessed immediately after injury

Behavioral observation required — not self-reported irritability or emotional distress.

Unable to follow two-part commands — observed inability to follow two-step instructions immediately after injury

Requires direct observation or reliable reconstruction. Example: asked to state their name and the date and was unable to do so.

Observed disorientation — disoriented to time, place, or situation immediately following injury

Example: repeatedly asking what happened or where they were. Must be witnessed or reconstructed — not "feeling confused," which is Criterion 3.

Clinical note — source hierarchy for Criterion 2 · Silverberg & Iverson et al., 2023, p. 1349 (Box 2)

Criterion 2 is met by: (1) direct observation in person or by video review; (2) collateral witness report; (3) review of acute care records; or (4) only when none of the above are available — the person's own recount of the injury event. The person's self-report is the last resort, not the primary source.

Clinical note — retrospective application of AMS · p. 1350

When no witness or records exist, the clinician may pose a hypothetical: "Would you have been able to answer questions about where you were and what happened immediately after the injury?" Observable behaviors reconstructed this way can be counted as signs. Subjectively experienced feelings of altered mental status — such as "feeling confused" or "feeling dazed" — belong in Criterion 3, not Criterion 2.

Clinical note — retrospective bias for Criteria 1, 2 & 3 · p. 1352

When applying Criteria 1, 2, and 3 retrospectively through history-taking, consider possible recall bias, response bias, and confounding factors. Post-acute evaluation "relies heavily on the accuracy of a person's retrospective recollection about the injury event and their experience of acute signs and symptoms. As such, there is a risk for both false positive and false negative diagnoses depending upon how accurately the diagnostic criteria can be applied." (p. 1352)

iii. Amnesia

Complete or partial amnesia for events immediately following the injury (post-traumatic amnesia, PTA)

Or retrograde amnesia if PTA cannot be reliably assessed due to polytrauma or sedating analgesics. Per the article (p. 1350), retrograde amnesia should only be considered when PTA assessment is precluded.

iv. Other Acute Neurological Sign

Observed motor incoordination upon standing immediately following injury

Seizure immediately following injury

Tonic posturing immediately following injury

No clinical signs selected — Pathway A not met.

Pathway B

Symptoms + Objective Finding — Criteria 3 & 4

When clinical signs (Pathway A) are absent or unclear, Pathway B requires both components below.

Threshold: At least 2 acute symptoms (Criterion 3) AND at least 1 clinical/lab finding (Criterion 4) — BOTH required for Pathway B.

Criterion 3 — Acute Symptoms

Select all that apply. Two or more symptoms are required. Two symptoms within the same category counts. Onset of mental status symptoms must be immediate; physical, cognitive, and emotional symptoms may be delayed a few hours but nearly always appear within 72 hours of injury.

i. Acute Mental Status Symptoms (onset must be immediate)0

Feeling confused

Feeling disoriented

Feeling dazed

ii. Physical Symptoms (may be delayed hours; within 72 hrs)0

Headache

Nausea

Dizziness

Balance problems

Vision problems

Sensitivity to light (photophobia)

Sensitivity to noise (phonophobia)

iii. Cognitive Symptoms (may be delayed hours; within 72 hrs)0

Feeling slowed down

"Mental fog" or mental cloudiness

Difficulty concentrating

Memory problems

iv. Emotional Symptoms (may be delayed hours; within 72 hrs)0

Uncharacteristic emotional lability (mood swings not typical for this person)

Uncharacteristic irritability

Total symptoms selected: 0 / 2 required for Criterion 3

Criterion 4 — Clinical Examination & Laboratory Findings

At least one objective finding is required when using Pathway B. These findings must be attributable to brain injury. Note: most findings lose diagnostic accuracy after ~72 hours post-injury.

Threshold: 1 finding required (in addition to the 2+ symptoms above).

Abnormal cognitive testing or neuropsychological finding attributable to the injury

e.g., impaired immediate memory, processing speed, or attention on objective test

Abnormal balance or postural stability finding

e.g., on BESS, objective balance assessment

Abnormal oculomotor or vestibular-ocular finding

e.g., on VOMS (smooth pursuit, saccades, VOR, near-point convergence)

Elevated blood-based biomarker consistent with brain injury

e.g., GFAP elevation — note: investigational, optimal cut-offs not yet established

Pathway B not yet met.

Pathway C

Neuroimaging Evidence — Criterion 5

A trauma-related abnormality on neuroimaging is sufficient to confirm TBI. Most individuals with mild TBI will have normal neuroimaging — this pathway applies only when imaging was performed and was abnormal.

Threshold: ONE unambiguous trauma-related intracranial abnormality on CT or structural MRI is sufficient for Pathway C alone.

CT or structural MRI reveals an unambiguous trauma-related intracranial abnormality

e.g., contusion, hemorrhage, or other intracranial finding attributable to the injury. Per ACRM 2023 (Box 1, p. 1348), this adds the qualifier "with neuroimaging evidence of structural intracranial injury" but retains the mild TBI classification.

No neuroimaging performed, or neuroimaging was normal

Most mild TBI cases have normal imaging — Pathway C is not applicable in this case.

Pathway C not applicable — neuroimaging normal or not performed.

Your Results

⚖ Important Notice

These results are for educational and training purposes only. They do not reflect a clinical opinion, professional assessment, or endorsement by Dr. Ramezani or the Center for Cognition & Compassion regarding any individual or situation. Results may not be reproduced, cited, or introduced in any legal, administrative, or regulatory proceeding. Formal neuropsychological evaluation by a licensed clinician is required for all clinical and forensic purposes.

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Your results are private — no data is transmitted to any server, stored externally, or accessible by any third party.

Privacy: No data transmitted to any server. All responses remain in your local browser only.

Reference & Attribution

Primary Citation

Silverberg ND, Iverson GL; ACRM Brain Injury Special Interest Group Mild TBI Task Force members. The American Congress of Rehabilitation Medicine Diagnostic Criteria for Mild Traumatic Brain Injury. Arch Phys Med Rehabil. 2023;104(8):1343–1355. doi: 10.1016/j.apmr.2023.03.036

About This Tool

This inventory was developed by Amir Ramezani, PhD, neuropsychologist, Center for Cognition & Compassion, CCC Forensic, for educational and professional training purposes only. It is not a validated clinical instrument, has not undergone formal psychometric evaluation, and does not replace neuropsychological or medical evaluation by a qualified professional.

Scope & Limitations

The 2023 ACRM criteria on which this tool is based are classification criteria, not prognostic criteria. They do not predict recovery trajectory, symptom duration, functional outcome, or injury severity beyond the mild/non-mild distinction. This tool reflects those criteria as educational content only and does not constitute a clinical instrument, a standardized test, or a normative assessment.

No Legal Use

Results generated by this tool may not be introduced, cited, reproduced, or relied upon in any legal proceeding, insurance claim, workers' compensation matter, or adversarial context. Use of this tool by attorneys, paralegals, claims adjusters, or any non-clinician for litigation-related purposes is expressly outside its intended scope. The developer and the Center for Cognition & Compassion disclaim any responsibility arising from such use.

Privacy

No personally identifiable information is collected, stored, or transmitted. All responses remain within your local browser and are not accessible to the developer, the Center for Cognition & Compassion, or any third party.

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