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Table 1 Characteristics of the studies

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

First author, Inclusion criteria Number of Intervention Outcomes and results Risk of biasa(specific areas of risk of bias)
publication year   participants    
  Studies including children only     
Bell [34] Age <16 years old, mTBI of <48 hours’ duration, n = 366 366 Scheduled phone contact in the first 3 months, standardized instruction handout, and a toll-free phone number CDC booklet (Facts about concussion and brain injury and where to get help), versus usual care Fewer symptoms and less effect of symptoms on functioning at 6 months for the intervention group according to the post-traumatic symptom composite score (52.6 versus 46.0). No difference in general health composite score Low
Casey [29] 6 months to 14 years old. minor head trauma but exclusion of patients who loss consciousness 340 Discharge interview during which the nurse explained a take-home booklet of symptoms and phone follow-up carried out the day after discharge, versus usual care No influence on a list of post-concussion symptoms 1 month after the accident Potential (unclear for sequence allocation, concealment and blinding. No reporting of confounding and poor outcome measure)
Ponsford [37] 6 to 15 years old, mTBI, GCS 13 to 15 130 Contacted in 48 hours and received neuropsychological assessment in 5 to 7 days plus information booklet, versus no follow-up and no booklet Less post-concussion symptoms in the intervention group at 3 months Potential (not randomized, no concealment confounding)
  Studies including adults and children     
Af Geijerstam [41] > 5 years old, mTBI within the previous 24 hours, GCS of 15 2602 Immediate CT scan of the head versus admission No statistically significant difference, Glasgow outcome scale not returned to normal at 3 months (21.4% versus 24.2%) Low
  Studies including mainly adults   Pharmaceutical intervention   
Filipova [28] 18 to 60 years old mTBI 17 Nasal DDAVP (10 μg twice daily) for 5 days versus placebo Intervention was associated with better results on information-processing test (PASAT) and verbal logical memory after 3 days of treatment. However, no effect seen on four other tests Low
    Information at discharge   
Hinkle [30] mTBI or skull fracture, GCS 13 to 15 1092 Standardized information at discharge, versus standardized information plus reassurance plus phone follow-up, versus routine care Patient return to work and social activities in the information and information plus reassurance group occurred at least 1 week sooner than in the routine treatment group Unclear (sequence allocation, concealment, blinding and outcome measure)
Mittenberg [32] Patients admitted for mTBI (adults), GCS 13 to 15 58 A 1 hour meeting with a therapist plus a 10 page manual plus a 10 minute questionnaire, versus routine care Intervention associated with shorter duration of symptoms (33 versus 51 days) and fewer symptoms at follow-up at 6 months Unclear (sequence allocation, concealment, blinding and confounding)
Paniak [31] Adults, mTBI in the previous 3 weeks, exclusion of patients known to have psychiatric disorder 119 Three to four hours of neuropsychological and personality assessment and treatment as needed plus single session with investigator session and a brochure, versus a single session with investigator and a brochure No effect of intervention on social functioning and SF-36 Low
    Follow-up strategies   
Andersson [33, 42] 16 to 60 years old, mTBI 395 Telephone contact at 2 to 8 weeks, follow-up in rehabilitation medicine, and outpatient appointment weekly as needed, versus usual care No difference in post-concussion symptoms at 1 year or 10 years after mTBI Unclear (concealment)
Ghaffar [35] 16 to 60 years old, mTBI presenting to the emergency department 191 Follow-up in a multidisciplinary clinic within 1 week and then as needed, and treatment according to specific complaints, versus no follow-up No effect on the RPCSQ Unclear (sequence allocation, concealment, confounding, blinding, and fidelity to protocol)
Heskestad [36] > 15 years old, minimal, mild and moderate TBI 326 Follow-up in neurosurgery clinic within 12 to 17 days after the accident, versus no follow-up No effect of intervention on post-concussion symptoms Potential (not randomized. no concealment. 15% completed the study)
Ponsford [39] > 15 years old, mTBI 262 Contacted in 48 hours and received neuropsychological assessment in 5 to 7 days plus information booklet, versus no follow-up and no booklet Fewer post-concussion symptoms related to anxiety in the intervention group at 3 months Potential (not randomized, no concealment confounding)
Wade [38] 16 to 65 years old, head injury of any severity 1156 Approached at 7 to 10 days after injury and offered additional information, advice, support, and intervention as needed, versus no follow-up No benefit on the RPCSQ at 6 months Low
    Other interventions   
De Kruijk [40] > 15 years old, mTBI of 6 hours or more 107 Full bed rest for 6 days followed by gradual mobilization versus gradual mobilization No effect of bed rest on symptoms secondary to concussion at 2 weeks, 3 months, and 6 months Unclear (concealment, and fidelity to protocol)
Lowdon [19] 18 to 50 years old, minor head injury with loss of consciousness 114 Admission overnight versus discharge Admission had no effect on the incidence and had a deleterious effect on the duration of symptoms for 6 weeks Unclear (sequence allocation, concealment, and fidelity to protocol)
  1. Abbreviations: CDC Centers for Disease Control, CT computed tomography, DDAVP 1-deamino-8-D-arginine vasopressin, GCS Glasgow Coma Scale, mTBI mild traumatic brain injury, PASAT Paced Auditory Serial Addition Test, RPCSQ Rivermead Post-Concussion Symptoms Questionnaire, SF-36 Short Form 36.
  2. aRisk of bias criteria according to the Cochrane and EPOC Risk of Bias tool.