Citation

Eliyahu L, Kirkland S, Campbell S, Rowe BH. Acad. Emerg. Med. 2016; 23(5): 531-542.

Affiliation

School of Public Health, University of Alberta, Edmonton, AB, Canada.

Copyright

(Copyright © 2016, Society for Academic Emergency Medicine, Publisher John Wiley and Sons)

DOI

10.1111/acem.12924

PMID

26825870

Abstract

OBJECTIVES: Concussions or mild traumatic brain injury (mTBI) are a major public health concern accounting for 85% of all brain injuries. Post-concussion syndrome (PCS) has been found to affect between 15-25% of patients with concussion one year after the initial injury. The goal of this review is to assess the effectiveness of early educational information or interventions provided in the Emergency Department (ED) on the onset and/or severity of PCS.

METHODS: A comprehensive literature search strategy involving seven electronic databases was developed. A grey literature search of Google Scholar, recent conference proceedings in Emergency Medicine, bibliographies of included studies and clinical trial registries was also performed. The citation list was reviewed independently by two reviewers; no restrictions on publication status or language of publication were applied. The Cochrane risk of bias (RoB) tool and the Newcastle-Ottawa scale (NOS) were used to assess quality.

RESULTS: From 1325 citations retrieved, four RCTs and one controlled clinical trial met inclusion criteria. Interventions identified in these studies included: educational information sheets, with or without telephone or in person follow up, and one study on bed rest. While rarely requested, one study offered referrals and additional treatment, if needed. None of the studies were deemed to be high quality. Heterogeneity among outcome reporting, follow up dates and interventions used precluded a pooled analysis. Overall, only two of the five included studies involving adult patients receiving early educational interventions reported a significant improvement in PCS symptoms. No reduction in PCS symptoms was found in the study on bed rest interventions.

CONCLUSION: Limited evidence exists regarding the effectiveness of early educational interventions following concussion. Standardization of the interventions, outcome measures, and follow-up periods would make quantitative comparisons more valid. Moreover, higher quality research in the field of early interventions for patients in the acute care setting is urgently required. This article is protected by copyright. All rights reserved.

Language: en