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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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Association between standardized information interventions compared with routine or no information on multiple post-concussion symptoms at 1 to 3 months.
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Figure 3: Association between standardized information interventions compared with routine or no information on multiple post-concussion symptoms at 1 to 3 months.

Mentions: Four studies evaluated a standardized information intervention provided in the ED. Three studies [29-31] reported that the intervention was not more effective than usual care in decreasing post-concussion symptoms, while one study [32] reported that meeting with a specialized therapist and the provision of a 10-page information booklet decreased post-concussion symptoms among adults admitted for mTBI. One study suggested that standardized information and reassurance provided at the ED was associated with faster return to work and social activities [30]. The baseline characteristics of these studies allowed us to conduct a meta-analysis using two studies [29,30] that reported outcomes on individual signs or symptoms secondary to mTBI at 1 to 3 months following a standardized information intervention provided in the acute setting. However, the pooled data failed to show an association between the intervention and the persistence of headache (relative risk (RR) = 0.88; 95% CI 0.65 to 1.19) or vision impairment (RR = 0.58; 95% CI 0.10 to 3.31). The major limitations of this analysis related to the fact that the study population was different for the two articles (adults versus children) and that one of the studies had a potential risk of bias according to our evaluation. A funnel plot is provided in the supplementary material (Figure 3).


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)

Association between standardized information interventions compared with routine or no information on multiple post-concussion symptoms at 1 to 3 months.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Association between standardized information interventions compared with routine or no information on multiple post-concussion symptoms at 1 to 3 months.
Mentions: Four studies evaluated a standardized information intervention provided in the ED. Three studies [29-31] reported that the intervention was not more effective than usual care in decreasing post-concussion symptoms, while one study [32] reported that meeting with a specialized therapist and the provision of a 10-page information booklet decreased post-concussion symptoms among adults admitted for mTBI. One study suggested that standardized information and reassurance provided at the ED was associated with faster return to work and social activities [30]. The baseline characteristics of these studies allowed us to conduct a meta-analysis using two studies [29,30] that reported outcomes on individual signs or symptoms secondary to mTBI at 1 to 3 months following a standardized information intervention provided in the acute setting. However, the pooled data failed to show an association between the intervention and the persistence of headache (relative risk (RR) = 0.88; 95% CI 0.65 to 1.19) or vision impairment (RR = 0.58; 95% CI 0.10 to 3.31). The major limitations of this analysis related to the fact that the study population was different for the two articles (adults versus children) and that one of the studies had a potential risk of bias according to our evaluation. A funnel plot is provided in the supplementary material (Figure 3).

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