Abstract
A recently published review of 45 studies concluded that approximately half of individuals who sustain a single mild traumatic brain injury (MTBI) experience long-term cognitive impairment (McInnes et al. Mild Traumatic Brain Injury (mTBI) and chronic cognitive impairment: A scoping review. PLoS ONE 2017;12:e0174847). Stratified by age, they reported that 50% of children and 58% of adults showed some form of cognitive impairment. We contend that the McInnes et al. review used a definition of “cognitive impairment” that was idiosyncratic, not applicable to individual patients or subjects, inconsistent with how cognitive impairment is defined in clinical practice and research, and resulted in a large number of false positive cases of cognitive impairment. For example, if a study reported a statistically significant difference on a single cognitive test, the authors concluded that every subject with a MTBI in that study was cognitively impaired–an approach that cannot be justified statistically or psychometrically. The authors concluded that impairment was present in various cognitive domains, such as attention, memory, and executive functioning, but they did not analyze or report the results from any of these specific cognitive domains. Moreover, their analyses and conclusions regarding many published studies contradicted the interpretations provided by the original authors of those studies. We re-reviewed all 45 studies and extracted the main conclusions from each. We conclude that a single MTBI is not associated with a high incidence of chronic cognitive impairment.
Highlights
A recently published scoping review of the literature concluded that approximately half of individuals who sustain a single mild traumatic brain injury (MTBI) experience long-term cognitive impairment [1]
Stratified by age, they reported that 50% of children and 58% of adults showed some form of cognitive impairment. They asserted that “a large proportion of individuals with a single mTBI will continue to demonstrate measurable impairment in various cognitive domains including executive function, learning/memory, attention, processing speed, and language function long after the initial injury”. They stated that the published literature to date represents a “gross underestimation” of the extent of cognitive impairment caused by a single MTBI, and “it is possible that our results represent a further underestimation of the incidence of persistent cognitive impairment following a single mTBI”
We re-reviewed the 45 articles identified in the McInnes et al scoping review [1] to examine the sampling strategy and statistical techniques used when determining if participants who experienced an MTBI had cognitive impairment
Summary
A recently published scoping review of the literature concluded that approximately half of individuals who sustain a single mild traumatic brain injury (MTBI) experience long-term cognitive impairment [1]. The authors identified 45 studies that met their inclusion criteria Through their synthesis and analysis, they reported that “1963 participants out of 3593, or approximately 55% of our sample collapsed across all time points showed cognitive impairment” (page 10). Stratified by age, they reported that 50% of children and 58% of adults showed some form of cognitive impairment (page 11). They asserted that “a large proportion of individuals with a single mTBI will continue to demonstrate measurable impairment in various cognitive domains including executive function, learning/memory, attention, processing speed, and language function long after the initial injury” (page 13). They stated that the published literature to date represents a “gross underestimation” (pages 13 and 14) of the extent of cognitive impairment caused by a single MTBI, and “it is possible that our results represent a further underestimation of the incidence of persistent cognitive impairment following a single mTBI” (page 14)
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