EXPERT REPORT FROM A SURGEON FOLLOWING CR ANIOCEREBRAL TRAUMA

The officially appointed external expert needs a precise documentation of the initial clinical findings and the findings at follow-up of the patient with craniocerebral trauma. The next step in preparation of t he expert report consists in a pathophysiological and a neurological e xamination, including CT scan and EEG repeated at intervals; a stable condition can be expected after 1-2 years. In the case of reversible c losed head syndrome (brain concussion) the expert should certify a dis ability for about 6 months; a degree of 20% for over 3 months should n ot be certified unless there are massive vegetative signs and symptoms . Persisting damage should only be recognized if a substantial brain l esion is present. In cases of cerebral compression or open skull fract ure with manifest damage to the substance of the brain the duration of unconsciousness must be taken into account. For children and young pe ople up to 10 days' unconsciousness is not taken to imply later disabi lity; after 10 - 20 days' unconsciousness such young people are consid ered fit for work or school to a qualified extent; a persistent defect must be expected to follow unconsciousness lasting over 20 days. Adul ts who are unconscious for up to 5 days can be expected to make a comp lete recovery, while a longer duration of coma and more advanced age a re associated with a worse outcome. The degree of functional impairmen t ist thus important in the expert's decision on the level of disabili ty. A flow chart is presented for guidance in the preparation of exper t reports. A brain lesion detectable by CT scan can be present without resulting functional impairment; in this case the expert should sugge st a 20% disability. The expert report should conclude with suggestion s for rehabilitation direct at reducing the level of disability.