Non-surgical intervention and cost for mild traumatic brain injury: results of the who collaborating centre task force on mild traumatic brain injury
Jörgen Borg A1, Lena Holm A2, Paul M. Peloso A3, J. David Cassidy A2, Linda J. Carroll A4, Hans von Holst A6, Chris Paniak A7, David Yates A8
A1 Department of Neuroscience Rehabilitation Medicine Uppsala University Hospital Uppsala Sweden
A2 Section for Personal Injury Prevention, Department of Clinical Neurosciences Karolinska Institutet Stockholm Sweden
A3 Department of Internal Medicine University of Iowa Health Center Iowa City Iowa USA
A4 Alberta Center for Injury Control and Research, Department of Public Health Sciences University of Alberta Edmonton Alberta Canada
A5 Department of Medicine University of Alberta Edmonton Alberta Canada
A6 Department of Neurosurgery Karolinska Institutet Stockholm Sweden
A7 Glenrose Rehabilitation Hospital and University of Alberta Canada
A8 Emergency Department Hope Hospital University of Manchester UK
We examined the evidence for non-surgical interventions and for economic costs for mild traumatic brain injury patients by a systematic search of the literature and a best-evidence synthesis. After screening 38,806 abstracts, we critically reviewed 45 articles on intervention and accepted 16 (36%). We reviewed 16 articles on economic costs and accepted 7 (44%). We found some evidence that early educational information can reduce long-term complaints and that this early intervention need not be intensive. Most cost studies were performed more than a decade ago. Indirect costs are probably higher than direct costs. Studies comparing costs for routine hospitalized observation vs the use of computerized tomography scan examination for selective hospital admission indicate that the latter policy reduces costs, but comparable clinical outcome of these policies has not been demonstrated. The sparse scientific literature in these areas reflects both conceptual confusion and limited knowledge of the natural history of mild traumatic brain injury.
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