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 | |||||
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) |