Non-surgical intervention and cost for mild traumatic brain injury: results of the who collaborating centre task force on mild traumatic brain injury

Borg, Jörgen; Holm, Lena W.; Peloso, Paul M.; Cassidy, J. David; Carroll, Linda; Holst, Hans von; Paniak, Chris; Yates, David

doi:10.1080/16501960410023840

Cited by 139 publications

(101 citation statements)

References 24 publications

(62 reference statements)

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“…Along the health care continuum, it is likely that some of these patients then receive conflicting diagnoses by neurologist, neurosurgeons, neuro-psychologists, and psychiatrists who are using different definitions of mTBI. Given that simple early patient education has been shown to reduce long-term complaints following mTBI, the value of accurately identifying mTBI cases is clear 15,16 .…”

mentioning

confidence: 99%

Early Identification and Incidence of Mild TBI in Ontario

Ryu

Feinstein

Colantonio

et al. 2009

Can. j. neurol. sci.

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Mild traumatic brain injury (mTBI) accounts for 70 to 90% of all TBI cases and is a major source of morbidity with up to 15 to 20% of patients experiencing long-term complaints [1][2][3][4][5] . Surprisingly, early detection of mTBI continues to be a considerable challenge. There is a discrepancy between the emphasis on acute injury characteristics such as post-traumatic amnesia (PTA) in the definitions found in mTBI literature, and the operational definitions of mTBI used in clinical settings [6][7][8][9] . Surveys of European hospitals and US Level I trauma centres found that there was little agreement in how mTBI was diagnosed [9][10][11] . Specifically, only 46% of the US Level I trauma centres reported using a formal evaluation for all diagnosed ABSTRACT: Objectives: (1) To examine the variability in diagnosis of mild traumatic brain injury (mTBI) in primary care relative to that of an expert reviewer; and (2) to determine the incidence rate of mTBI in Ontario, Canada. Method: Potential mTBI cases were identified through reviewing three months of Emergency Department (ED) and Family Physician (FP) health records. Potential cases were selected from ED records using the International Classification of Disease, 9th revision, Clinical Modification and External Cause codes and from all FPs records for the time period. Documented diagnoses of mTBI were compared to expert reviewer diagnosis. Incidence of mTBI was determined using the documented diagnoses and data from hospital catchment areas and population census. Results: 876 potential mTBI cases were identified, 25 from FP records. Key indicators of mTBI were missing on many records (e.g., 308/876 records had Glasgow Coma Scale (GCS) scores). The expert reviewer disagreed with the documented diagnosis in 380/876 cases (kappa=0.19). The expert reviewer was more likely to give a diagnosis if the GCS was 13-14, if there was documented loss of consciousness and/or post-traumatic amnesia, and/or if there was pathology found on an acute brain scan. Calculated incidence rates of hospital-treated mTBI were 426 or 535/100,000 (expert review -hospital diagnosis). Including family physician cases increased the rate to 493 or 653/100,000. Conclusion: Health record documentation of key indicators for mTBI is often lacking. Notwithstanding, some patients with mTBI appear to be missed or misdiagnosed by primary care physicians. A more comprehensive case definition resulted in estimated incidence rates higher than previous reports. RÉSUMÉ: Identification précoce et incidence du traumatisme cérébral léger en Ontario. Objectifs :(1) Examiner la variabilité dans le diagnostic du traumatisme cérébral léger (TCL) en première ligne par rapport au diagnostic d'un réviseur expert et (2) déterminer le taux d'incidence du TCL en Ontario, Canada. Méthode : Nous avons identifié les cas potentiels de TCL par révision des dossiers du service des urgences et des médecins de famille sur une période de trois mois. Les cas potentiels identifiés à partir des dossiers du service des urgences au m...

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mentioning

confidence: 99%

Early Identification and Incidence of Mild TBI in Ontario

Ryu

Feinstein

Colantonio

et al. 2009

Can. j. neurol. sci.

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“…Ponsford et al 11 studied 202 mild TBI patients and reported that patients given an information booklet on mild TBI and coping strategies for symptoms were significantly less symptomatic at 3 months than those who were not provided education. An extensive review of articles on early intervention after mild TBI by Borg et al 58 showed that early educational information reduces long-term complaints.…”

Section: Discussionmentioning

confidence: 99%

Neurobehavioral sequelae of traumatic brain injury

Riggio

Wong

2009

Mount Sinai J Medicine

106

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The neurobehavioral sequelae of traumatic brain injury consist of a spectrum of somatic and neuropsychiatric symptoms. The neuropsychiatric symptoms are divided into cognitive and behavioral presentations. In the literature, these neurobehavioral sequelae have been called postconcussive symptoms, postconcussive syndrome, and postconcussive disorder; however, the authors of this review do not use this terminology because the symptoms are not restricted to patients with concussion but instead can be found in all traumatic brain injury patients of all injury severities. The development of neurobehavioral sequelae after traumatic brain injury is a multifactorial process. The patient evaluation requires a multidisciplinary approach in order to delineate physiologic dysfunction and place deficits in the context of the patient's preinjury and postinjury psychiatric status. Consequently, the evaluation of the posttraumatic brain injury patient with neurobehavioral sequelae requires a carefully structured history and physical examination with an emphasis on neurological and psychiatric function. Adjunctive evaluations must be tailored to the patient with neuroimaging, neurophysiological, and neuropsychiatric testing. Maximized outcomes may be achieved by the performance of a careful and detailed assessment that places complaints within the context of the individual.

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“…Three systematic reviews reported only one clinical trial of a pharmacological intervention for concussion. [23][24][25] One study showed no effect of nasal vasopressin on cognitive symptoms secondary to mild TBI. 26 A systematic review identified studies investigating interventions initiated in the ED for short-term (one week) and medium term (one month) outcomes in adults and children who sustained mild TBI.…”

Section: Discussionmentioning

confidence: 99%

Ondansetron for pediatric concussion; a pilot study for a randomized controlled trial

Gravel

Carrière

D’Angelo

et al. 2016

CJEM

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Objectives: Assess the feasibility of a study evaluating one dose of oral ondansetron to decrease post-concussion symptoms at one week and one month following concussion in children aged 8 to 17 years old. Method: This was a pilot study for a randomized, triple-blind controlled trial of one dose of either ondansetron or placebo performed in a tertiary care pediatric emergency department. Participants were children aged 8 to 17 years who sustained a concussion in the previous 24 hours and visited a single emergency department. The outcome of interest was an increase from pre-concussion baseline of at least 3 symptoms from the Post-Concussion Symptom Inventory, measured at one week and at one month following concussion. The primary outcome was to determine the proportion of children who completed the assessment at one week following the intervention. Secondary outcome was the proportion of children who completed the assessment at one month following the intervention. All children, care givers, and those assessing the outcomes were blinded to the group assignment. Results: Of the 218 children presenting with a concussion during the study period, we screened 108 and found 36/108 (33%) eligible to participate and 16/108 (14.8%) agreed to participate. All enrolled patients were compliant with the intervention and follow-up. Conclusion: In our study population, approximately one-third of the screened concussion patients were eligible to participate and approximately one half of those eligible agreed to participate. Our study found that most enrolled patients preferred electronic follow-up; the noncompliance rate was minimal.

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Non-surgical intervention and cost for mild traumatic brain injury: results of the who collaborating centre task force on mild traumatic brain injury

Cited by 139 publications

References 24 publications

Early Identification and Incidence of Mild TBI in Ontario

Early Identification and Incidence of Mild TBI in Ontario

Neurobehavioral sequelae of traumatic brain injury

Ondansetron for pediatric concussion; a pilot study for a randomized controlled trial

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