Management of Concussion and Mild Traumatic Brain Injury: A Synthesis of Practice Guidelines

Abstract

At least 3 million Americans sustain a mild traumatic brain injury (mTBI) each year, and 1 in 5 have symptoms that persist beyond 1 month. Standards of mTBI care have evolved rapidly, with numerous expert consensus statements and clinical practice guidelines published in the last 5 years. This Special Communication synthesizes recent expert consensus statements and evidenced-based clinical practice guidelines for civilians, athletes, military, and pediatric populations for clinicians practicing outside of specialty mTBI clinics, including primary care providers. The article offers guidance on key clinical decisions in mTBI care and highlights priority interventions that can be initiated in primary care to prevent chronicity.

A prospective cohort study investigating contributors to mild cognitive impairment in adults with spinal cord injury: study protocol

“…Additionally, participants will be interviewed at the time consent is obtained with proxy questions assessing the presence of any self-report TBI indicators that were evident at the time of injury, to corroborate diagnostic evidence available from medical records. A probabilistic approach will be used to identify the occurrence of TBI by cross-checking clinically-documented evidence of TBI against self-reported information relevant to TBI [ 82 ].…”

Expert Panel Survey to Update the American Congress of Rehabilitation Medicine Definition of Mild Traumatic Brain Injury

“…Between January and March of 2019, a Working Group from the ACRM Mild TBI Task Force (co-led by NDS and GLI) identified potential Expert Panel members for the updated case definition project by scanning author lists of mild TBI agreement statements and clinical practice guidelines published within the last 5 years, 6,8,[20][21][22][23][24][25] asking for nominations from Working Group members, and conducting literature searches for high-impact articles. The target sample size was 20 to 40 individuals to ensure reliability of group judgments while limiting coordination difficulties and diminishing returns with an excessively large Expert Panel.…”

Neuromodulation for Mild Traumatic Brain Injury Rehabilitation: A Systematic Review

“…Following a mTBI, the general consensus guidelines put forward by the American Medical Society for Sports Medicine (Harmon et al, 2019), suggest that the first priority is to rule out any cervical spine injuries or neurological emergencies and to consider whether brain imaging is indicated (Silverberg et al, 2019). Once the individual is medically stable, education is provided about the nature of mTBI, the expectation of a short recovery process and how to manage any symptoms that may arise (Government of South Australia, 2009;Prince and Bruhns, 2017).…”

“…A recent review on the evaluation and treatment of mTBI suggests that education limits the development of persistent symptoms and a lack of education and patient discharge information seems to be associated with complex recovery, reducing the likelihood that an individual will follow up with a neurologist in the presence of persistent symptoms (Prince and Bruhns, 2017). Finally, when the symptoms are stable a gradual return to daily activities, without symptom exacerbation is encouraged (Harmon et al, 2019;Silverberg et al, 2019). Although this outlines the recommended approach, a systematic and comprehensive approach may not always be used.…”

“…In fact, as reported by Prince and Bruhns (2017), there is a paucity of research addressing treatment of PPCS in mTBI, with methodological inconsistencies being a major factor identified in the literature. This gap in the evidence base for mTBI treatment, warrants further exploration by researchers and clinicians alike, of potential interventions that may assist individuals with persistent symptoms in the post-acute phase (Silverberg et al, 2019). This may include vestibular and ocular assessments, reviewing medication side-effects, biochemical investigations, screening for depression and anxiety, as well as cognitive neuropsychological assessments where indicated (Silverberg et al, 2019).…”