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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


Outcomes and results

Risk of biasa(specific areas of risk of bias)

publication year




Studies including children only


Bell [34]

Age <16 years old, mTBI of <48 hours’ duration, n = 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


Casey [29]

6 months to 14 years old. minor head trauma but exclusion of patients who loss consciousness


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


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


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%)



Studies including mainly adults


Pharmaceutical intervention


Filipova [28]

18 to 60 years old mTBI


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



Information at discharge


Hinkle [30]

mTBI or skull fracture, GCS 13 to 15


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


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


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



Follow-up strategies


Andersson [33, 42]

16 to 60 years old, mTBI


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


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


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


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


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



Other interventions


De Kruijk [40]

> 15 years old, mTBI of 6 hours or more


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


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.