Randomized treatment trial in mild traumatic brain injury

Ghaffar, Omar; McCullagh, Scott; Ouchterlony, Donna; Feinstein, Anthony

doi:10.1016/j.jpsychores.2005.07.018

Cited by 83 publications

(76 citation statements)

References 50 publications

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“…Early interventions or follow-ups have not improved outcome, most likely as a consequence of recruiting patients who might have recovered within a few weeks regardless of treatment [21,[41][42][43]. Matuseviciene et al offered an early intervention visit to a select group of patients with three PCS at ten days post-injury, but this intervention showed no effect on RTW compared to the control [14].…”

Section: Discussionmentioning

confidence: 99%

Multidisciplinary outpatient treatment in patients with mild traumatic brain injury: A randomised controlled intervention study

et al. 2017

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Objective: To evaluate the efficacy of a multidisciplinary outpatient follow-up programme compared to follow-up by a general practitioner for patients being at risk or sick-listed with persistent post-concussion symptoms two months after a mild traumatic brain injury. Design: Randomised controlled trial.Patients: One hundred fifty-one patients, 16-56 years.Methods: Multidisciplinary outpatient rehabilitation with individual contacts and a psychoeducational group intervention at two outpatient rehabilitation clinics compared to follow-up by a general practitioner after a multidisciplinary examination. Primary outcome was sustainable return-to-work first year post-injury. Secondary outcomes were post-concussion symptoms, disability, the patient's impressions of change and psychological distress.Results: Days to sustainable return-to-work was 90 in the intervention and 71 in the control group (p=0.375). The number of post-concussion symptoms were fewer in the intervention (6) compared to the control group (8) at 12 months (p=0.041). No group differences were observed for disability (p=0.193), patients impression of change (p=0.285) or psychological distress (p=0.716).2 Conclusion:The multidisciplinary outpatient follow-up programme focusing on better understanding and reassurance of favourable outcome for mild traumatic brain injury did not improve return-to-work, but may have reduced the development of post-concussion symptoms.Additional studies should focus on which factors exhibit a direct impact on return-to-work.

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Section: Discussionmentioning

confidence: 99%

Multidisciplinary outpatient treatment in patients with mild traumatic brain injury: A randomised controlled intervention study

et al. 2017

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“…Clinically, the missing documented (or simply missing) and misdiagnosed cases of mTBI may result in increased difficulty for patients. Those who do have an mTBI but do not receive a diagnosis may not receive interventions that in some instances could be helpful 28,29 . Early intervention is particularly important in patients with pre-injury psychiatric problems in preventing longterm complaints 28 .…”

Section: Discussionmentioning

confidence: 99%

“…Those who do have an mTBI but do not receive a diagnosis may not receive interventions that in some instances could be helpful 28,29 . Early intervention is particularly important in patients with pre-injury psychiatric problems in preventing longterm complaints 28 . Conversely patients who receive the diagnosis of mTBI without actually having one may be subject to unnecessary worry and stress.…”

Section: Discussionmentioning

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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“…Among them, one evaluated a pharmacological intervention (DDAVP), 27 two evaluated activity restriction (full bed rest, 28 hospitalization 29 ), one evaluated head tomodensitometry v. admission, 30 four evaluated an information intervention (pamphlet, information session at the ED) [31][32][33][34] and seven evaluated diverse followup interventions (in neuropsychology, phone follow-up, etc.). 33,[35][36][37][38][39][40] Since the publication of the last systematic review, a small randomized controlled trial reported fewer headaches associated with hypertonic intravenous saline v. normal saline for 44 concussed children who needed intravenous access for CT-scan. 41 Ondansetron usage remained limited to patients who suffered from nausea following chemotherapy until a decade ago when research began to emerge supporting its use in children with acute gastroenteritis.…”

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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Randomized treatment trial in mild traumatic brain injury

Cited by 83 publications

References 50 publications

Multidisciplinary outpatient treatment in patients with mild traumatic brain injury: A randomised controlled intervention study

Multidisciplinary outpatient treatment in patients with mild traumatic brain injury: A randomised controlled intervention study

Early Identification and Incidence of Mild TBI in Ontario

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

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