A systematic review of treatments for mild traumatic brain injury

Comper, Paul; Bisschop, SM; Carnide, Nancy; Tricco, Andrea C.

doi:10.1080/02699050400025042

Cited by 222 publications

(156 citation statements)

References 44 publications

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“…Included in the online supplemental materials, Appendix A includes the references for all 131 studies. cognitive outcomes (Comper, Hutchison, Magrys, Mainwaring, & Richards, 2010), and two summarized experimental mTBI treatments (Comper, Bisschop, Carnide, & Tricco, 2005;Snell, Surgenor, Hay-Smith, & Siegert, 2009). Table 2 summarizes quantitative study information (e.g., study quality, sample size) as well as reported overall effect size estimates for each meta-analysis and their associated U 1 /2 and U G /2 statistics.…”

Section: Resultsmentioning

confidence: 99%

The neuropsychological outcomes of concussion: A systematic review of meta-analyses on the cognitive sequelae of mild traumatic brain injury.

2014

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Mild Traumatic Brain Injury (mTBI), also known as concussion, has become a growing public health concern, prevalent in both athletic and military settings. Many researchers have examined post-mTBI neuropsychological outcomes, leading to multiple meta-analyses amalgamating individual study results. Objective: Considering the plethora of meta-analytic findings, the next logical step stands as a systematic review of meta-analyses, effectively reporting key moderators that predict post-mTBI neuropsychological outcomes. Method: A systematic review of reviews yielded 11 meta-analyses meeting inclusion criteria (i.e., English-language systematic reviews/meta-analyses covering post-mTBI observational cognitive research on late adolescents/adults), with their findings qualitatively synthesized based on moderator variables (i.e., cognitive domain, time since injury, past head injury, participant characteristics, comparison group, assessment technique, and persistent symptoms). Results: The overall effect sizes ranged for both general (range: .07-.61) and sports-related mTBI (range: .40 -.81) and differed both between and within cognitive domains, with executive functions appearing most sensitive to multiple mTBI. Cognitive domains varied in recovery rates, but overall recovery occurred by 90 days postinjury for most individuals and by 7 days postinjury for athletes. Greater age/education and male gender produced smaller effects sizes, and high school athletes suffered the largest deficits post-mTBI. Controlgroup comparisons yielded larger effects than within-person designs, and assessment techniques had limited moderating effects. Conclusions: Overall, meta-analytic review quality remained low with few studies assessing publication or study quality bias. Meta-analyses consistently identified adverse acute mTBI-related effects and fairly rapid symptom resolution. Future meta-analyses should better operationally define cognitive constructs to produce more consistent effect estimates across domains. Keywords: mTBI, concussion, mild traumatic brain injury, cognition, neuropsychologySupplemental materials: http://dx.doi.org/10.1037/neu0000037.supp Mild Traumatic Brain Injury (mTBI), also known as concussion, stands as a prevalent neurotrauma within the general population , increasingly common in both athletic (Coronado, McGuire, Faul, Sugerman, & Pearson, 2012) and military settings (Iverson, Langlois, McCrea, & Kelly, 2009). The rates and consequences of mTBI have become progressively more publicized, both in sports (Moser, 2007) and in modern conflicts (Hayward, 2008). Highly prevalent in American football (Gessel, Fields, Collins, Dick, & Comstock, 2007), mTBI now represents a signature injury of the sport. Although its seriousness has been historically underestimated, repeated mTBIs among young athletes have been linked to significant neurodegeneration long after retiring from play (Gavett, Stern, & McKee, 2011;Guskiewicz et al., 2005;McKee et al., 2009). In 2011, Dave Duerson, a former American football safety, took his o...

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Section: Resultsmentioning

confidence: 99%

The neuropsychological outcomes of concussion: A systematic review of meta-analyses on the cognitive sequelae of mild traumatic brain injury.

2014

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“…In such situations it can sometimes be very difficult to establish a diagnosis of mild TBI definitively. Definitions of mild TBI vary considerably across studies (Comper et al, 2005). The American Congress of Rehabilitation Medicine has presented criteria for mild TBI, defining a loss of consciousness (LOC) of less than 30 min, and posttraumatic amnesia (PTA) of less than 24 h (American Congress of Rehabilitation Medicine, 1993).…”

Section: Maas Et Almentioning

confidence: 99%

Standardizing Data Collection in Traumatic Brain Injury

Maas

Harrison-Felix

Menon

et al. 2011

Journal of Neurotrauma

149

137

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Collaboration among investigators, centers, countries, and disciplines is essential to advancing the care for traumatic brain injury (TBI). It is thus important that we ''speak the same language.'' Great variability, however, exists in data collection and coding of variables in TBI studies, confounding comparisons between and analysis across different studies. Randomized controlled trials can never address the many uncertainties concerning treatment approaches in TBI. Pooling data from different clinical studies and high-quality observational studies combined with comparative effectiveness research may provide excellent alternatives in a cost-efficient way. Standardization of data collection and coding is essential to this end. Common data elements (CDEs) are presented for demographics and clinical variables applicable across the broad spectrum of TBI. Most recommendations represent a consensus derived from clinical practice. Some recommendations concern novel approaches, for example assessment of the intensity of therapy in severely injured patients. Up to three levels of detail for coding data elements were developed: basic, intermediate, and advanced, with the greatest level of detail attained in the advanced version. More detailed codings can be collapsed into the basic version. Templates were produced to summarize coding formats, explanation of choices, and recommendations for procedures. Endorsement of the recommendations has been obtained from many authoritative organizations. The development of CDEs for TBI should be viewed as a continuing process; as more experience is gained, refinement and amendments will be required. This proposed process of standardization will facilitate comparative effectiveness research and encourage high-quality meta-analysis of individual patient data.

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“…Three systematic reviews reported only one clinical trial of a pharmacological intervention for concussion. [23][24][25] One study showed no effect of nasal vasopressin on cognitive symptoms secondary to mild TBI. 26 A systematic review identified studies investigating interventions initiated in the ED for short-term (one week) and medium term (one month) outcomes in adults and children who sustained mild TBI.…”

Section: Discussionmentioning

confidence: 99%

Ondansetron for pediatric concussion; a pilot study for a randomized controlled trial

Gravel

Carrière

D’Angelo

et al. 2016

CJEM

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Objectives: Assess the feasibility of a study evaluating one dose of oral ondansetron to decrease post-concussion symptoms at one week and one month following concussion in children aged 8 to 17 years old. Method: This was a pilot study for a randomized, triple-blind controlled trial of one dose of either ondansetron or placebo performed in a tertiary care pediatric emergency department. Participants were children aged 8 to 17 years who sustained a concussion in the previous 24 hours and visited a single emergency department. The outcome of interest was an increase from pre-concussion baseline of at least 3 symptoms from the Post-Concussion Symptom Inventory, measured at one week and at one month following concussion. The primary outcome was to determine the proportion of children who completed the assessment at one week following the intervention. Secondary outcome was the proportion of children who completed the assessment at one month following the intervention. All children, care givers, and those assessing the outcomes were blinded to the group assignment. Results: Of the 218 children presenting with a concussion during the study period, we screened 108 and found 36/108 (33%) eligible to participate and 16/108 (14.8%) agreed to participate. All enrolled patients were compliant with the intervention and follow-up. Conclusion: In our study population, approximately one-third of the screened concussion patients were eligible to participate and approximately one half of those eligible agreed to participate. Our study found that most enrolled patients preferred electronic follow-up; the noncompliance rate was minimal.

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A systematic review of treatments for mild traumatic brain injury

Abstract: There are few rigorous studies evaluating treatment of MTBI. Limitations of the current literature are presented.

Cited by 222 publications

References 44 publications

The neuropsychological outcomes of concussion: A systematic review of meta-analyses on the cognitive sequelae of mild traumatic brain injury.

The neuropsychological outcomes of concussion: A systematic review of meta-analyses on the cognitive sequelae of mild traumatic brain injury.

Standardizing Data Collection in Traumatic Brain Injury

Ondansetron for pediatric concussion; a pilot study for a randomized controlled trial

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