Critical evaluation of the existing guidelines on mild traumatic brain injury
Paul M. Peloso A1, Linda J. Carroll A2, J. David Cassidy A2, Jörgen Borg A5, Hans von Holst A6, Lena Holm A4, David Yates A7
A1 Department of Internal Medicine University of Iowa Health Center Iowa City Iowa USA
A2 Alberta Centre for Injury Control and Research, Department of Public Health Sciences University of Alberta Edmonton Alberta Canada
A3 Department of Medicine University of Alberta Edmonton Alberta Canada
A4 Section for Personal Injury Prevention, Department of Clinical Neurosciences Karolinska Institutet Stockholm Sweden
A5 Department Neuroscience, Rehabilitation Medicine Uppsala University Uppsala Sweden
A6 Department of Neurosurgery Karolinska Institutet Stockholm Swede
A7 Emergency Department, Hope Hospital University of Manchester Manchester UK
The purpose of guidelines is to reduce practice variability, but they need to be evidence-based. We examine current mild traumatic brain injury guidelines, critique their basis in evidence and examine their variability in recommendations. A systematic search of the literature found 38,806 abstracts, with 41 guidelines. There were 18 sports-related guidelines, 13 related to admission policies, 12 related to imaging and 5 related to neuropsychological assessment. Some guidelines addressed several areas. Only 5 guidelines reported a methodology for the assembly of evidence used to develop the guideline. After appraising the guidelines against a validated index, we found that 3 of the 41 guidelines could be categorized as evidence-based. Two of these focused on paediatric patients and 1 on adult patients. Limited methodological quality in the current guidelines results in conflicting recommendations amongst them.
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