Advertisement

Systematic Review of the Prognosis After Mild Traumatic Brain Injury in Adults: Cognitive, Psychiatric, and Mortality Outcomes: Results of the International Collaboration on Mild Traumatic Brain Injury Prognosis

  • Linda J. Carroll
    Correspondence
    Corresponding author Linda J. Carroll, PhD, 4075 RTF, 8308–114 St, Edmonton, AB, Canada, T6G 2E1.
    Affiliations
    School of Public Health and Alberta Centre for Injury Control and Research, University of Alberta, Edmonton, Canada
    Search for articles by this author
  • J. David Cassidy
    Affiliations
    Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada

    Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

    Institute of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark

    Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
    Search for articles by this author
  • Carol Cancelliere
    Affiliations
    Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada

    Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
    Search for articles by this author
  • Pierre Côté
    Affiliations
    Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

    Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

    Faculty of Health Sciences, University of Ontario Institute of Technology-Canadian Memorial Chiropractic College Centre for the Study of Disability Prevention and Rehabilitation, Toronto, Ontario, Canada
    Search for articles by this author
  • Cesar A. Hincapié
    Affiliations
    Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada

    Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
    Search for articles by this author
  • Vicki L. Kristman
    Affiliations
    Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

    Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada

    Institute of Work and Health, Toronto, Ontario, Canada

    Division of Human Sciences, Northern Ontario School of Medicine, Lakehead University, Thunder Bay, Ontario, Canada
    Search for articles by this author
  • Lena W. Holm
    Affiliations
    Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
    Search for articles by this author
  • Jörgen Borg
    Affiliations
    Department of Clinical Sciences, Rehabilitation Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
    Search for articles by this author
  • Catharina Nygren-de Boussard
    Affiliations
    Department of Clinical Sciences, Rehabilitation Medicine, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
    Search for articles by this author
  • Jan Hartvigsen
    Affiliations
    Institute of Sports Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark

    Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark
    Search for articles by this author

      Abstract

      Objective

      To synthesize the best available evidence on objective outcomes after adult mild traumatic brain injury (MTBI).

      Data Sources

      MEDLINE and other databases were searched (2001–2012) for studies related to MTBI. Inclusion criteria included published, peer-reviewed articles in English and other languages. References were also identified from the bibliographies of eligible articles.

      Study Selection

      Randomized controlled trials and cohort and case-control studies were selected according to predefined criteria. Studies had to have a minimum of 30 MTBI cases and assess objective outcomes in adults.

      Data Extraction

      Eligible studies were critically appraised using a modification of the Scottish Intercollegiate Guidelines Network (SIGN) criteria. Two reviewers independently reviewed each study and extracted data from accepted articles into evidence tables.

      Data Synthesis

      Evidence was synthesized qualitatively according to modified SIGN criteria, and studies were categorized as exploratory or confirmatory based on the strength of their design and evidence. After 77,914 records were screened, 299 were found to be relevant and critically reviewed, and 101 were deemed scientifically admissible. Of these, 21 studies that were related to the objective outcomes form the basis of this review. Most evidence indicates the presence of cognitive deficits in the first 2 weeks post-MTBI, and some evidence suggests that complete recovery may take 6 months or a year. A small number of studies indicate that MTBI increases the risk of psychiatric illnesses and suicide.

      Conclusions

      Early cognitive deficits are common, and complete recovery may be prolonged. Conclusions about mortality post-MTBI are limited. This review has implications for expected recovery after MTBI and MTBI-related health sequelae. Well-designed confirmatory studies are needed to understand the medium- to long-term consequences of MTBI and to further evaluate the effect of prior MTBI and injury severity on recovery.

      Keywords

      List of abbreviations:

      APOE (apolipoprotein E), CT (computed tomography), GCS (Glasgow Coma Scale), ICoMP (International Collaboration on MTBI Prognosis), LOC (loss of consciousness), MTBI (mild traumatic brain injury), PTA (posttraumatic amnesia), SIGN (Scottish Intercollegiate Guidelines Network), TBI (traumatic brain injury), WHO (World Health Organization)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cassidy J.D.
        • Carroll L.J.
        • Peloso P.M.
        • et al.
        Incidence, risk factors and prevention of mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury.
        J Rehabil Med. 2004; 36: 28-60
        • Schretlen D.J.
        • Shapiro A.M.
        A quantitative review of the effects of traumatic brain injury on cognitive functioning.
        Inter Rev Psych. 2003; 15: 341-349
        • Dikmen S.S.
        • Corrigan J.D.
        • Levin H.S.
        • MacHamer J.
        • Stiers W.
        • Weisskopf M.G.
        Cognitive outcome following traumatic brain injury.
        J Head Trauma Rehabil. 2009; 24: 430-438
        • Carroll L.J.
        • Cassidy J.D.
        • Peloso P.M.
        • et al.
        Prognosis for mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury.
        J Rehabil Med. 2004; 36: 84-105
        • Carroll L.J.
        • Cassidy J.D.
        • Holm L.
        • Kraus J.
        • Coronado V.G.
        WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Methodological issues and research recommendations for mild traumatic brain injury: the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury.
        J Rehabil Med. 2004; 36: 113-125
      1. Iverson GL, Gaetz M. Practical considerations for interpreting change following brain injury. In: Lovell MR, Echemendia RJ, Barth JT, Collins MW, editors. Traumatic brain injury in sports. Lisse: Swets & Zeitlinger; 2004. p 323-355.

        • Cancelliere C.
        • Cassidy J.D.
        • Côté P.
        • et al.
        Protocol for a systematic review of prognosis after mild traumatic brain injury: an update of the WHO Collaborating Centre Task Force findings.
        Syst Rev. 2012; 1: 17
        • Cancelliere C.
        • Cassidy J.D.
        • Li A.
        • Donovan J.
        • Côté P.
        • Hincapié C.A.
        Systematic search and review procedures: results of the International Collaboration on Mild Traumatic Brain Injury Prognosis.
        Arch Phys Med Rehabil. 2014; 95: S101-S131
        • National Center for Injury Prevention and Control
        Report to Congress on mild traumatic brain injury in the United States: steps to prevent a serious public health problem.
        Centers for Disease Control and Prevention, Atlanta2003
      2. Healthcare Improvement Scotland. SIGN 1993-2013. Available at: http://www.sign.ac.uk/. Accessed November 13, 2013.

        • Côté P.
        • Cassidy J.D.
        • Carroll L.
        • Frank J.W.
        • Bombardier C.
        A systematic review of the prognosis of acute whiplash and a new conceptual framework to synthesize the literature.
        Spine. 2001; 26: E445-E458
        • Suhr J.A.
        • Gunstad J.
        “Diagnosis Threat”: the effect of negative expectations on cognitive performance in head injury.
        J Clin Exp Neuropsychol. 2002; 24: 448-457
        • Suhr J.A.
        • Gunstad J.
        Further exploration of the effect of “diagnosis threat” on cognitive performance in individuals with mild head injury.
        J Int Neuropsychol Soc. 2005; 11: 23-29
        • Ozen L.J.
        • Fernandes M.A.
        Effects of “diagnosis threat” on cognitive and affective functioning long after mild head injury.
        J Int Neuropsychol Soc. 2011; 17: 219-229
        • Gil S.
        • Caspi Y.
        • Ben-Ari I.Z.
        • Koren D.
        • Klein E.
        Does memory of a traumatic event increase the risk for posttraumatic stress disorder in patients with traumatic brain injury? A prospective study.
        Am J Psychiatry. 2005; 162: 963-969
        • Iverson G.
        Complicated vs uncomplicated mild traumatic brain injury: acute neuropsychological outcome.
        Brain Inj. 2006; 20: 1335-1344
        • Landre N.
        • Poppe C.J.
        • Davis N.
        • Schmaus B.
        • Hobbs S.E.
        Cognitive functioning and postconcussive symptoms in trauma patients with and without mild TBI.
        Arch Clin Neuropsychol. 2006; 21: 255-273
        • Nygren-de Boussard C.
        • Lundin A.
        • Karlstedt D.
        • Edman G.
        • Bartfai A.
        • Borg J.
        S100 and cognitive impairment after mild traumatic brain injury.
        J Rehabil Med. 2005; 37: 53-57
        • Heitger M.H.
        • Jones R.D.
        • Dalrymple-Alford J.C.
        • Frampton C.M.
        • Ardagh M.W.
        • Anderson T.J.
        Motor deficits and recovery during the first year following mild closed head injury.
        Brain Inj. 2006; 20: 807-824
        • Shanmukhi S.
        • Panigrahi M.
        Serial pattern learning after mild head injury.
        Neurol India. 2003; 51: 518-521
        • Brewer T.L.
        • Metzger B.L.
        • Therrien B.
        Trajectories of cognitive recovery following a minor brain injury.
        Res Nurs Health. 2002; 25: 269-281
        • Tellier A.
        • Marshall S.C.
        • Wilson K.G.
        • Smith A.
        • Perugini M.
        • Stiell I.G.
        The heterogeneity of mild traumatic brain injury: where do we stand?.
        Brain Inj. 2009; 23: 879-887
        • Sundström A.
        • Marklund P.
        • Nilsson L.G.
        • et al.
        APOE influences on neuropsychological function after mild head injury: within-person comparisons.
        Neurology. 2004; 62: 1963-1966
        • Kerr Z.Y.
        • Marshall S.W.
        • Guskiewicz K.M.
        Reliability of concussion history in former professional football players.
        Med Sci Sports Exerc. 2012; 44: 377-382
        • Fann J.R.
        • Burington B.
        • Leonetti A.
        • Jaffe K.
        • Katon W.J.
        • Thompson R.S.
        Psychiatric illness following traumatic brain injury in an adult health maintenance organization population.
        Arch Gen Psychiatry. 2004; 61: 53-61
        • Teasdale T.W.
        • Engberg A.W.
        Suicide after traumatic brain injury: a population study.
        J Neurol Neurosurg Psychiatry. 2001; 71: 436-440
        • Nielsen A.S.
        • Mortensen P.B.
        • O'Callaghan E.
        • Mors O.
        • Ewald H.
        Is head injury a risk factor for schizophrenia?.
        Schizophr Res. 2002; 55: 93-98
        • De Silva M.J.
        • Roberts I.
        • Perel P.
        • et al.
        Patient outcome after traumatic brain injury in high-, middle- and low-income countries: analysis of data on 8927 patients in 46 countries.
        Int J Epidemiol. 2009; 38: 452-458
        • Pentland B.
        • Hutton L.S.
        • Jones P.A.
        Late mortality after head injury.
        J Neurol Neurosurg Psychiatry. 2005; 76: 395-400
        • Selassie A.W.
        • Fakhry S.M.
        • Ford D.W.
        Population-based study of the risk of in-hospital death after traumatic brain injury: the role of sepsis.
        J Trauma. 2011; 71: 1226-1234
        • Heitger M.H.
        • Macaskill M.R.
        • Jones R.D.
        • Anderson T.J.
        The impact of mild closed head injury on involuntary saccadic adaptation: evidence for the preservation of implicit motor learning.
        Brain Inj. 2005; 19: 109-117
        • Kristman V.L.
        • Côté P.
        • Yang X.
        • Hogg-Johnson S.
        • Vidmar M.
        • Rezai M.
        Health care utilization of workers' compensation claimants associated with mild traumatic brain injury: a historical population-based cohort study of workers injured in 1997-1998.
        Arch Phys Med Rehabil. 2014; 95: S295-S302
        • Cancelliere C.
        • Hincapié C.A.
        • Keightley M.
        • et al.
        Systematic review of prognosis and return to play after sport concussion: results of the International Collaboration on Mild Traumatic Brain Injury Prognosis.
        Arch Phys Med Rehabil. 2014; 95: S210-S229
        • Boyle E.
        • Cancelliere C.
        • Hartvigsen J.
        • Carroll L.J.
        • Holm L.W.
        • Cassidy J.D.
        Systematic review of prognosis after mild traumatic brain injury in the military: results of the International Collaboration on Mild Traumatic Brain Injury Prognosis.
        Arch Phys Med Rehabil. 2014; 95: S230-S237
        • Kristman V.L.
        • Borg J.
        • Godbolt A.K.
        • et al.
        Methodological issues and research recommendations for prognosis after mild traumatic brain injury: results of the International Collaboration on Mild Traumatic Brain Injury Prognosis.
        Arch Phys Med Rehab. 2014; 95: S265-S277