Abstract
BackgroundMost 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.MethodsWe 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.ResultsFrom 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.ConclusionsThere 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.
Highlights
Most patients who sustain mild traumatic brain injury have persistent symptoms at 1 week and 1 month after injury
The main limitations of that review were that it included articles published only until the year 2000, and it did not evaluate the effects of interventions on outcomes at 1 week and 1 month
The objective of the current study was to identify all clinical trials of interventions that could be initiated in an acute setting for patients who sustain mild traumatic brain injury (mTBI)
Summary
Most patients who sustain mild traumatic brain injury (mTBI) have persistent symptoms at 1 week and 1 month after injury. Most studies suggest that the long-term evolution of mTBI is excellent, with complete resolution of symptoms in 3 months [15,16,17], 55 to 90% of patients who sustain mTBI experience post-concussion symptoms during the week following the accident [15,18,19]. The nature of these symptoms can be cognitive (memory loss, attention deficit), somatic (headache, fatigue, nausea), or psychological (depression, irritability). The objective of the current study was to identify all clinical trials of interventions that could be initiated in an acute setting for patients who sustain mTBI
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