Methodological issues and research recommendations for mild traumatic brain injury: the who collaborating centre task force on mild traumatic brain injury

Abstract

The WHO Collaborating Centre for Neurotrauma Task Force on Mild Traumatic Brain Injury performed a comprehensive search and critical review of the literature published between 1980 and 2002 to assemble the best evidence on the epidemiology, diagnosis, prognosis and treatment of mild traumatic brain injury. Of 743 relevant studies, 313 were accepted on scientific merit and comprise our best-evidence synthesis. The current literature on mild traumatic brain injury is of variable quality and we report the most common methodological flaws. We make recommendations for avoiding the shortcomings evident in much of the current literature and identify topic areas in urgent need of further research. This includes the need for large, well-designed studies to support evidence-based guidelines for emergency room triage of children with mild traumatic brain injury and to explore more fully the issue of prognosis after mild traumatic brain injury in the elderly population. We also advocate use of standard criteria for defining mild traumatic brain injury and propose a definition.

Neuropsychology and clinical neuroscience of persistent post-concussive syndrome

“…In such a group it would be reasonable that additional data could be obtained that would provide more information about the biomechanics of injury and a host of other medical and demographic factors, including attempts to be establish preinjury level of function. In one of the largest reviews of mTBI, the WHO task force that reviewed mTBI literature up to 2004 concluded that mTBI research is "of varying quality and causal inferences are often mistakenly drawn from cross-sectional studies (p. 84," (Carroll et al, 2004a), see also (Ragnarsson, 2006) The only correction for this gaffe in the neuropsychology of concussion, and potential long-term sequelae of PPCS, will be large, unbiased prospective studies that address the issues raised in this review. The importance of understanding this more accurately and completely is the fact that concussion is reportedly the most common of all neurological injuries and this is also true of the Iraq and Afghanistan war (Das & Moorthi, 2005;Okie, 2005;Warden, 2006;Warden & French, 2005), where unofficial estimates place the numbers in the tens of thousands (Bob Woodruff Reports.…”

“…systemic injuries, facial injuries or intubation), caused by other problems (e.g., psychological trauma, language barrier or coexisting medical conditions) or caused by penetrating craniocerebral injury, p. 115). (Carroll et al, 2004a) of what is now currently known about the neuropathological and pathophysiological basis of concussion will be offered. The last part of the review will focus on more traditional neuropsychological concepts as they relate to concussion and conclude with suggestions on improved research tactics on this topic.…”

“…It is in these individuals that neuropsychological research needs to direct its best and most unbiased research efforts. Unfortunately, as pointed out by the World Health Organization's task force on mTBI, poor research designs and the cross-sectional nature of many of the studies on this topic, restrict generalizations of the findings (Carroll et al, 2004a;Carroll et al, 2004b). What can be done to correct short-comings of research in this area?…”

Pilot study to develop telehealth tinnitus management for persons with and without traumatic brain injury

“…Mild TBI, synonymous with concussion, is the most frequently occurring category, comprising approximately 85 percent of all TBI episodes [3]. Mild TBI has been clinically operationalized as a nonpenetrating force to the head that results in (1) confusion or disorientation, LOC for 30 min or less, posttraumatic amnesia for less than 24 h, and/or other transient neurological abnormalities such as focal signs, seizure, and intracranial lesion not requiring surgery; and (2) a Glasgow Coma Scale score of 13 to 15 after 30 min postinjury or later upon presentation for healthcare [4]. TBI of all severity levels can cause substantial long-term functional disability among survivors [1].…”

Disparities in Disability After Traumatic Brain Injury Among Hispanic Children and Adolescents

“…14,15 Mild TBI was further subdivided into 3 categories: mild I (no abnormalities on computed tomography [CT] or no CT was performed); mild II (skull fracture without intracranial hemorrhage); and mild III (intracranial hemorrhage but case still meet criteria for mild TBI).…”