Brief report
Systematic Search and Review Procedures: Results of the International Collaboration on Mild Traumatic Brain Injury Prognosis

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Abstract

Objectives

To update the last best-evidence synthesis conducted by the World Health Organization Collaborating Centre for Neurotrauma, Prevention, Management and Rehabilitation in 2002; and to describe the course, identify prognostic factors, determine long-term sequelae, identify effects of interventions for mild traumatic brain injury (MTBI), identify knowledge gaps in the literature, and make recommendations for future research.

Data Sources

MEDLINE, Embase, PsycINFO, Cumulative Index to Nursing and Allied Health, and SPORTDiscus were searched between 2001 and 2012. Inclusion criteria included published peer-reviewed articles in English and 5 other languages. References were also identified from relevant reviews and meta-analyses and the bibliographies of eligible articles.

Study Selection

Controlled trials and cohort and case-control studies were selected according to predefined inclusion/exclusion criteria. Studies had to have at least 30 MTBI cases and assess outcomes relevant to prognosis after MTBI.

Data Extraction

Eligible studies were critically appraised using modified Scottish Intercollegiate Guidelines Network (SIGN) criteria. Two reviewers independently reviewed each study and extracted data from accepted articles (ie, with a low risk of bias) into evidence tables.

Data Synthesis

The evidence was synthesized qualitatively according to modified SIGN criteria and prioritized according to design as exploratory or confirmatory. The evidence was organized into separate articles according to population (eg, adults, children, and athletes) and outcomes (eg, risk of dementia after MTBI).

Conclusions

After 77,914 records were screened, 299 articles were eligible and reviewed. Of these, 101 (34%) were accepted as scientifically admissible and form the basis of our findings, which are organized into 10 articles in this supplement. These reviews present the best available evidence on MTBI prognosis, but more research is needed.

Section snippets

Methods

The review was conducted and reported in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.2 Our protocol was registered in the international prospective register of systematic reviews3 on July 11, 2011, and was last updated on November 2, 2012 (registration no. CRD42011001410). We also published the detailed protocol.4

Results

A total of 92,022 citations were identified from the electronic databases, and 138 citations were identified from other sources (ie, reference lists and original ICoMP studies) (fig 1). After duplicates were removed, 77,914 titles remained. After applying the inclusion and exclusion criteria to titles and abstracts, 75,744 records were excluded and 2170 full-text articles were assessed for eligibility. Of these, 299 articles were determined to be eligible and were critically reviewed, and 101

Discussion

We critically reviewed 299 articles relating to the prognosis of MTBI in order to update the WHO Collaborating Centre Task Force findings. We accepted 101 (34%) of these as scientifically admissible and based our findings on them.

We believe our review has several strengths. The investigative team includes international experts on clinical and methodologic issues in the field of traumatic brain injury. We developed a comprehensive and sensitive search strategy. We performed in-depth reviews of

Conclusions

We reviewed 299 articles and accepted 101 (34%), which form the basis of our findings. These consist of 4 RCTs, 1 nonrandomized experiment, 88 cohort studies (8 phase III, 46 phase II, 34 phase I), and 8 case-control studies (2 phase III, 5 phase II, 1 phase I). More methodologically rigorous studies are needed to better understand the prognosis after MTBI because very few confirmatory (phase III) studies were identified. Our results are presented in 10 separate articles in this supplement. We

Acknowledgments

We thank the other members of ICoMP: Jean-Luc af Geijerstam, MD, PhD, Jörgen Borg, MD, PhD, Eleanor Boyle, PhD, Linda J. Carroll, PhD, Victor G. Coronado, MD, MPH, Alison K. Godbolt, MBChB, MD, Jan Hartvigsen, DC, PhD, Lena W. Holm, DrMedSc, Ryan Hung, MD, MSc, Michelle Keightley, PhD, Vicki L. Kristman, PhD, Connie Marras, MD, PhD, Catharina Nygren-de Boussard, MD, PhD, Peter Rumney, MD, and Britt-Marie Stålnacke, MD, PhD. We also thank Panos Lambiris, MSc, Information Scientist, University

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Supported by the Ontario Neurotrauma Foundation (grant no. 2010-ABI-MTBIWHO-871).

The funder was not involved in the design or preparation of the study protocol or in the management of the project, analysis or interpretation of data, or the preparation of the final article.

No commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a benefit on the authors or on any organization with which the authors are associated.

The findings and conclusions in this research are those of the authors alone and do not necessarily represent the official views or policies of the Centers for Disease Control and Prevention or any agency of the United States government. Inclusion of individuals, programs, or organizations in this article does not constitute endorsement by the United States government.

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