Summary of the findings of the International Collaboration on Mild Traumatic Brain Injury Prognosis
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CHIROPRACTIC & MANUAL THERAPIES
REVIEW
Open Access
Summary of the findings of the International Collaboration on Mild Traumatic Brain Injury Prognosis James Donovan1*, Carol Cancelliere1,2 and J David Cassidy1,2,3
Abstract In 2004, the WHO Collaborating Centre for Neurotrauma, Prevention, Management and Rehabilitation Task Force published the first large systematic review and best evidence synthesis on the clinical course and prognosis for recovery after MTBI. Ten years later, the International Collaboration on Mild Traumatic Brain Injury Prognosis (ICoMP) formed to update the original WHO Task Force results. This summary review highlights important clinical findings from the full ICoMP results including the current evidence on the course and prognosis of recovery after MTBI in diverse patient populations (e.g., adults, athletes and children) and injury environments (e.g., motor vehicle collisions) as well as on the risk of long-term outcomes after MTBI, such as Parkinson’s disease and dementia. Additional clinical areas of interest in MTBI are also discussed including the similarities between MTBI and other traumatic injuries and the risk of Second Impact Syndrome after sport concussion. Clinicians can use this information to help inform patients on the likely course of recovery after MTBI/concussion and guide better decision-making in the care of these patients. Keywords: Prognosis, Concussion, Mild traumatic brain injury
Introduction Over the past decade, mild traumatic brain injury (MTBI) or concussion has become a prominent public health concern. The annual incidence likely now exceeds 600 per 100,000 person-years and though popularized by injuries to prominent sports figures, MTBI most commonly occurs after falls and motor vehicle collisions [1]. In 2004, the WHO Collaborating Centre for Neurotrauma, Prevention, Management and Rehabilitation Task Force (WHO Task Force) published the first large systematic review and best evidence synthesis on MTBI course and prognosis. After reviewing the literature from 1980–2000, the WHO Task Force found the prognostic literature to be of poor quality [2]. For instance, inconsistent MTBI definitions, weak study designs and pervasive biases were common problems throughout the literature. In addition, knowledge gaps were found in such areas as prognosis in the elderly, risk of long-term outcomes, and non-surgical * Correspondence: [email protected] 1 Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Canada Full list of author information is available at the end of the article
intervention studies [2]. The WHO Task Force concluded that more high quality prognostic research was needed to address these evidence gaps and advance the understanding on the course and prognosis after MTBI [3]. In 2011 an international group of 21 research scientists and clinicians, the International Collaboration on MTBI Prognosis (ICoMP), was formed and funded to update the WHO Task Force findings o
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