We searched the literature on the epidemiology, diagnosis, prognosis, treatment and costs of mild traumatic brain injury. Of 428 studies related to prognosis after mild traumatic brain injury, 120 (28%) were accepted after critical review. These comprise our best-evidence synthesis on prognosis after mild traumatic brain injury. There was consistent and methodologically sound evidence that children's prognosis after mild traumatic brain injury is good, with quick resolution of symptoms and little evidence of residual cognitive, behavioural or academic deficits. For adults, cognitive deficits and symptoms are common in the acute stage, and the majority of studies report recovery for most within 3-12 months. Where symptoms persist, compensation/litigation is a factor, but there is little consistent evidence for other predictors. The literature on this area is of varying quality and causal inferences are often mistakenly drawn from cross-sectional studies.Descriptive: 98.65% made good recovery, 0.25% died. All with LOC <15 minutes had good outcome. 5.9% developed seizures

We examined the evidence for non-surgical interventions and for economic costs for mild traumatic brain injury patients by a systematic search of the literature and a bestevidence synthesis. After screening 38,806 abstracts, we critically reviewed 45 articles on intervention and accepted 16 (36%). We reviewed 16 articles on economic costs and accepted 7 (44%). We found some evidence that early educational information can reduce long-term complaints and that this early intervention need not be intensive. Most cost studies were performed more than a decade ago. Indirect costs are probably higher than direct costs. Studies comparing costs for routine hospitalized observation vs the use of computerized tomography scan examination for selective hospital admission indicate that the latter policy reduces costs, but comparable clinical outcome of these policies has not been demonstrated. The sparse scientific literature in these areas reflects both conceptual confusion and limited knowledge of the natural history of mild traumatic brain injury.

The purpose of this study was to compare an education-oriented single session treatment (SS) for mild traumatic brain injury (MTBI) to a more extensive assessment, education, and treatment-as-needed intervention (TAN). Participants were 111 adults with MTBI who were recruited from consecutive admissions to two hospital emergency wards. They were randomly assigned to either the SS or TAN modality. The groups did not differ on any demographic, injury-related, or questionnaire variable when first seen within 3 weeks of injury. The groups generally improved a similar amount and did not differ from each other on any symptom-related, functional, or vocational variables 3-4 months after their baseline session. Patient satisfaction ratings with services provided were also similar for the two groups. Brief educational intervention given soon after MTBI appears to be adequate for most MTBI survivors.

This study provided 3-month follow-up data to a previous paper that compared symptom complaints of patients with mild traumatic brain injury (MTBI) with those of non-injured control participants within 1 month of injury. The 110 MTBI patients and 118 control participants were group-matched on age, gender, education level, and socioeconomic status. As a group, MTBI patients no longer endorsed significantly more symptoms (M = 14.09, S.D. = 10.77) than did the control group (M = 12.56, S.D. = 8.46, P = .232). Only 3 of the 43 queried symptoms were endorsed by significantly more (Bonferroni-corrected P < .00116) MTBI patients than controls. Using the same Bonferroni-corrected criteria, 10 of the 43 symptoms were endorsed at a significantly higher severity level by MTBI patients. Overall, the treated MTBI group's symptom complaints diminished from baseline to 3 months post-injury, with relatively few differences remaining between the two groups.

Demographic, injury-related, and symptom variables at intake, 3 months, and 12 months postinjury were compared between 50 treated adults with mild traumatic brain injury (MTBI) who were not seeking or receiving financial compensation at any time and 18 who were at each time. Compensation seekers/receivers reported symptom incidence and severity as approximately 1 SD higher at each time. The level of difference between the groups did not significantly differ across time. No demographic variables distinguished the groups. No injury-related variable other than more immediate postinjury prescription medication use was predictive of the greater symptom complaints for the patients seeking or receiving compensation. However, this medication effect did not explain away the compensation effect when medication use was co-varied in an analysis. Our study appears to be the first to examine the relationship between financial compensation and symptom report in an MTBI sample specifically treated for their condition. Our results indicate that even highly patient-rated treatment is not adequate to wash out the strong relationship between financial compensation status and symptom report after MTBI.