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

Gravel J, D'Angelo A, Carrière B, Crevier L, Beauchamp MH, Chauny JM, Wassef M, Chaillet N - Syst Rev (2013)

Bottom Line: 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.The large variability in outcomes measured in studies limits comparison between them.

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Affiliation: Département de Pédiatrie, CHU Sainte-Justine, Université de Montréal, Montréal, Canada. graveljocelyn@hotmail.com

ABSTRACT

Background: Most 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.

Methods: We 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.

Results: From 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.

Conclusions: There 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.

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Summary of the risk of bias for the 15 studies.
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Figure 2: Summary of the risk of bias for the 15 studies.

Mentions: Of the 15 studies, 5 presented a potential risk of bias. The main reasons for potential biases were related to the randomization sequence generation and the inadequate concealment of allocation of participants (Figure 2). The risk of bias was unclear for six studies. Most of these had unclear information about multiple components of the Risk of Bias tool. The most problematic components were sequence allocation and concealment.


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

Gravel J, D'Angelo A, Carrière B, Crevier L, Beauchamp MH, Chauny JM, Wassef M, Chaillet N - Syst Rev (2013)

Summary of the risk of bias for the 15 studies.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750385&req=5

Figure 2: Summary of the risk of bias for the 15 studies.
Mentions: Of the 15 studies, 5 presented a potential risk of bias. The main reasons for potential biases were related to the randomization sequence generation and the inadequate concealment of allocation of participants (Figure 2). The risk of bias was unclear for six studies. Most of these had unclear information about multiple components of the Risk of Bias tool. The most problematic components were sequence allocation and concealment.

Bottom Line: 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.The large variability in outcomes measured in studies limits comparison between them.

View Article: PubMed Central - HTML - PubMed

Affiliation: Département de Pédiatrie, CHU Sainte-Justine, Université de Montréal, Montréal, Canada. graveljocelyn@hotmail.com

ABSTRACT

Background: Most 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.

Methods: We 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.

Results: From 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.

Conclusions: There 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.

Show MeSH
Related in: MedlinePlus