Interventions provided in the acute phase for mild traumatic brain injury: a systematic review

Abstract

BackgroundMost patients who sustain mild traumatic brain injury (mTBI) have persistent symptoms at 1 week and 1 month after injury. This systematic review investigated the effectiveness of interventions initiated in acute settings for patients who experience mTBI.MethodsWe performed a systematic review of all randomized clinical trials evaluating any intervention initiated in an acute setting for patients experiencing acute mTBI. All possible outcomes were included. The primary sources of identification were MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Central register of Controlled Trials, from 1980 to August 2012. Hand searching of proceedings from five meetings related to mTBI was also performed. Study selection was conducted by two co-authors, and data abstraction was completed by a research assistant specialized in conducting systematic reviews. Study quality was evaluated using Cochrane’s Risk of Bias assessment tool.ResultsFrom a potential 15,156 studies, 1,268 abstracts were evaluated and 120 articles were read completely. Of these, 15 studies fulfilled the inclusion/exclusion criteria. One study evaluated a pharmacological intervention, two evaluated activity restriction, one evaluated head computed tomography scan versus admission, four evaluated information interventions, and seven evaluated different follow-up interventions. Use of different outcome measures limited the possibilities for analysis. However, a meta-analysis of three studies evaluating various follow-up strategies versus routine follow-up or no follow-up failed to show any effect on three outcomes at 6 to 12 months post-trauma. In addition, a meta-analysis of two studies found no effect of an information intervention on headache at 3 months post-injury.ConclusionsThere is a paucity of well-designed clinical studies for patients who sustain mTBI. The large variability in outcomes measured in studies limits comparison between them.

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

“…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.…”

“…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. 24 The review identified 15 randomized controlled trials. Among them, one evaluated a pharmacological intervention (DDAVP), 27 two evaluated activity restriction (full bed rest, 28 hospitalization 29 ), one evaluated head tomodensitometry v. admission, 30 four evaluated an information intervention (pamphlet, information session at the ED) [31][32][33][34] and seven evaluated diverse followup interventions (in neuropsychology, phone follow-up, etc.).…”

“…As mentioned, most children have persistent symptoms at one week post-concussion and one third of children at one month; 5,7 and there is no proven effective treatment for any outcome following concussion. 24 Concussion has clinical, societal, and financial impacts. Our results suggest that ondansetron could potentially be useful to limit persistence of postconcussion symptoms.…”

Management of Mild Traumatic Brain Injury Symptoms in a 31-Year-Old Woman Using Cervical Manipulation and Acupuncture: A Case Report

“…2 Currently, there is no one standard of care for mTBI outside of rest and avoidance of reinjury. 5,[9][10][11][12][13] This treatment method has been shown to decrease symptoms with time and reduce the risk of reinjury in athletes. 1,[10][11][12]16 In this case, the patient's mTBI symptoms interfered with her work duties and daily activities.…”

“…5,[9][10][11][12][13] Symptom education and material on future prevention are also commonly given as postconcussive treatment especially in an athletic population where return to play is a major focus. 6,13 Although rest and education have been found to reduce some mTBI symptoms, these can be insufficient as a treatment strategy in an adult, working population where symptoms often can be triggered by occupational duties and can greatly impact daily activities. Pharmaceutical treatment options, such as DDAVP, have demonstrated little positive effect on symptoms.…”