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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.

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.

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Related in: MedlinePlus

Association between follow-up interventions compared with routine or no follow-up on multiple post-concussion symptoms at 6–12 months. (a) Memory, (b) poor concentration, (c) headache, (d) dizziness, (e) vision impairment, (f) fatigue, (g) irritability, (h) anxiety, (i) depression, and (j) sensitivity to noise.
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Figure 4: Association between follow-up interventions compared with routine or no follow-up on multiple post-concussion symptoms at 6–12 months. (a) Memory, (b) poor concentration, (c) headache, (d) dizziness, (e) vision impairment, (f) fatigue, (g) irritability, (h) anxiety, (i) depression, and (j) sensitivity to noise.

Mentions: Seven studies evaluated the effect of a follow-up intervention compared with routine or no follow-up [33-39,42]. The interventions were of various types. For example, in one study, the intervention consisted of a phone follow-up, a neuropsychological evaluation at 1 week, and an information booklet [37], while in another study, the intervention was limited to a phone follow-up 2 to 8 weeks after the trauma [33]. Three studies showed a positive effect of the intervention [34,37,39]. These interventions were 1) an information booklet, phone follow-up in 48 hours, and follow-up in a specialized clinic 5 to 7 days after the trauma (evaluated in two studies); and 2) scheduled phone contact in the 3 months after trauma, in addition to an information handout and an information booklet. Importantly, two of these studies were potentially biased according to our evaluation. A meta-analysis was possible using four studies (one with children and three with adults) [33,34,36,38] that reported outcomes on individual signs or symptoms secondary to mTBI at 6 to 12 months after trauma. No association was seen between the intervention and headache (RR 0.98; 95% CI 0.80 to 1.37), poor concentration (1.13; 95% CI 0.78 to 1.64), memory problems (RR 1.17; 95% CI 0.74 to 1.86), dizziness (RR 0.58 95% CI 0.10 to 3.31), vision problems (RR 0.86; 95% CI 0.65 to 1.14), fatigue (1.09; 95% CI 0.69 to 1.48), irritability (1.03; 95% CI 0.79 to 1.35), anxiety (1.19; 95% CI 0.88 to 1.59), depression (1.16; 95% CI 0.91 to 1.49) or sensitivity to noise (1.17; 95% CI 0.74 to 1.86) (Figure 4a-j; see supplementary material). Many of these analyses identified important heterogeneity between studies with I2 values greater than 50%. However, secondary analysis of the two studies [33,38] comparing follow-up intervention with no follow-up showed a positive effect for follow-up intervention on the improvement of memory and concentration in adults (Figure 4a,b). Importantly, this sub-analysis showed no heterogeneity between studies.


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 follow-up interventions compared with routine or no follow-up on multiple post-concussion symptoms at 6–12 months. (a) Memory, (b) poor concentration, (c) headache, (d) dizziness, (e) vision impairment, (f) fatigue, (g) irritability, (h) anxiety, (i) depression, and (j) sensitivity to noise.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Association between follow-up interventions compared with routine or no follow-up on multiple post-concussion symptoms at 6–12 months. (a) Memory, (b) poor concentration, (c) headache, (d) dizziness, (e) vision impairment, (f) fatigue, (g) irritability, (h) anxiety, (i) depression, and (j) sensitivity to noise.
Mentions: Seven studies evaluated the effect of a follow-up intervention compared with routine or no follow-up [33-39,42]. The interventions were of various types. For example, in one study, the intervention consisted of a phone follow-up, a neuropsychological evaluation at 1 week, and an information booklet [37], while in another study, the intervention was limited to a phone follow-up 2 to 8 weeks after the trauma [33]. Three studies showed a positive effect of the intervention [34,37,39]. These interventions were 1) an information booklet, phone follow-up in 48 hours, and follow-up in a specialized clinic 5 to 7 days after the trauma (evaluated in two studies); and 2) scheduled phone contact in the 3 months after trauma, in addition to an information handout and an information booklet. Importantly, two of these studies were potentially biased according to our evaluation. A meta-analysis was possible using four studies (one with children and three with adults) [33,34,36,38] that reported outcomes on individual signs or symptoms secondary to mTBI at 6 to 12 months after trauma. No association was seen between the intervention and headache (RR 0.98; 95% CI 0.80 to 1.37), poor concentration (1.13; 95% CI 0.78 to 1.64), memory problems (RR 1.17; 95% CI 0.74 to 1.86), dizziness (RR 0.58 95% CI 0.10 to 3.31), vision problems (RR 0.86; 95% CI 0.65 to 1.14), fatigue (1.09; 95% CI 0.69 to 1.48), irritability (1.03; 95% CI 0.79 to 1.35), anxiety (1.19; 95% CI 0.88 to 1.59), depression (1.16; 95% CI 0.91 to 1.49) or sensitivity to noise (1.17; 95% CI 0.74 to 1.86) (Figure 4a-j; see supplementary material). Many of these analyses identified important heterogeneity between studies with I2 values greater than 50%. However, secondary analysis of the two studies [33,38] comparing follow-up intervention with no follow-up showed a positive effect for follow-up intervention on the improvement of memory and concentration in adults (Figure 4a,b). Importantly, this sub-analysis showed no heterogeneity between studies.

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