The Effectiveness of Early Educational Interventions in the Emergency Department to Reduce Incidence or Severity of Postconcussion Syndrome Following a Concussion: A Systematic Review

Abstract

Objectives: Concussions or mild traumatic brain injury are a major public health concern accounting for 85% of all brain injuries. Postconcussion syndrome (PCS) has been found to affect between 15 and 25% of patients with concussion 1 year after the initial injury. The goal of this review is to assess the effectiveness of early educational information or interventions provided in the emergency department on the onset and/or severity of PCS.Methods: A comprehensive literature search strategy involving seven electronic databases was developed. A grey literature search of Google Scholar, recent conference proceedings in emergency medicine, bibliographies of included studies, and clinical trial registries was also performed. The citation list was reviewed independently by two reviewers; no restrictions on publication status or language of publication were applied. The Cochrane risk-of-bias tool and the Newcastle-Ottawa scale were used to assess quality.Results: From 1,325 citations retrieved, four RCTs and one controlled clinical trial met inclusion criteria. Interventions identified in these studies included: educational information sheets, with or without telephone or in-person follow-up, and one study on bed rest. While rarely requested, one study offered referrals and additional treatment, if needed. None of the studies were deemed to be high quality. Heterogeneity among outcome reporting, follow-up dates and interventions used precluded a pooled analysis. Overall, only two of the five included studies involving adult patients receiving early educational interventions reported a significant improvement in PCS symptoms. No reduction in PCS symptoms was found in the study on bed rest interventions. Conclusion:Limited evidence exists regarding the effectiveness of early educational interventions following concussion. Standardization of the interventions, outcome measures, and follow-up periods would make quantitative comparisons more valid. Moreover, higher-quality research in the field of early interventions for patients in the acute care setting is urgently required.ACADEMIC EMERGENCY MEDICINE 2016;23:531-542

Cognitive Rest and Graduated Return to Usual Activities Versus Usual Care for Mild Traumatic Brain Injury: A Randomized Controlled Trial of Emergency Department Discharge Instructions

“…A recent systematic review of early educational interventions in the ED for MTBI concluded there are no clear and consistent interventions or standard management practices that exist for this population. 8 The review included five trials conducted in the ED, none of which were high quality. Significant heterogeneity precluded the authors from pooling the results of the ED interventions, which included educational information sheets, telephone or in-person follow-up, and advice for bed rest.…”

“…5 Despite the significant disability associated with PCS, there is paucity in the literature surrounding the prevention of PCS in patients with acute MTBI. 8 Current guidelines recommend a period of "cognitive rest" and stepwise return to usual activities following MTBI. [9][10][11][12][13] Cognitive rest is defined as the avoidance of mental activities that may trigger symptoms, such as watching television, using the computer, listening to music, exercising, reading or talking on the phone.…”

“…9 However, a recent systematic review concluded there is insufficient high-quality evidence to provide clear recommendations regarding any early interventions designed to decrease the severity of PCS following MTBI. 8 The primary objective of this study was to determine if patients randomized to cognitive rest and graduated return to usual activity discharge instructions had differences in their symptom resolution 2 weeks after MTBI compared to patients who received usual care discharge instructions.…”

Concussion: Improving Nurses' Knowledge in the Emergency Department

“…A systematic review by Eliyahu, Kirkland, Campbell & Rowe (2016) assessed the effectiveness of early educational interventions in the ED. Five studies were included in this systematic review utilizing the PRISMA methodology guidelines.…”

“…It was found that two of the five studies demonstrated significant improvement in patients' PCS symptoms after receiving early educational interventions. Despite these findings, the researchers determined that there was insufficient high-quality evidence to suggest that early interventions decrease PCS symptoms and the authors made no recommendations (Eliyahu, Kirkland, Campbell, & Rowe, 2016). Research is needed to determine what interventions are best for MTBI patients in order to produce evidence-based guidelines and improve outcomes.…”