| 1. |
- Cancelliere, Carol, et al.
(författare)
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Protocol for a systematic review of prognosis after mild traumatic brain injury : an update of the WHO Collaborating Centre Task Force findings
- 2012
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Ingår i: Systematic Reviews. - : Springer Science and Business Media LLC. - 2046-4053. ; :1, s. 17-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Mild traumatic brain injury (MTBI) is a major public-health concern and represents 70-90% of all treated traumatic brain injuries. The last best-evidence synthesis, conducted by the WHO Collaborating Centre for Neurotrauma, Prevention, Management and Rehabilitation in 2002, found few quality studies on prognosis. The objective of this review is to update these findings. Specifically, we aim to describe the course, identify modifiable prognostic factors, determine long-term sequelae, and identify effects of interventions for MTBI. Finally, we will identify gaps in the literature, and make recommendations for future research.Methods: The databases MEDLINE, PsychINFO, Embase, CINAHL and SPORTDiscus were systematically searched (2001 to date). The search terms included 'traumatic brain injury', 'craniocerebral trauma', 'prognosis', and 'recovery of function'. Reference lists of eligible papers were also searched. Studies were screened according to pre-defined inclusion and exclusion criteria. Inclusion criteria included original, published peer-reviewed research reports in English, French, Swedish, Norwegian, Danish and Spanish, and human participants of all ages with an accepted definition of MTBI. Exclusion criteria included publication types other than systematic reviews, meta-analyses, randomized controlled trials, cohort studies, and case-control studies; as well as cadaveric, biomechanical, and laboratory studies. All eligible papers were critically appraised using a modification of the Scottish Intercollegiate Guidelines Network (SIGN) criteria. Two reviewers performed independent, in-depth reviews of each eligible study, and a third reviewer was consulted for disagreements. Data from accepted papers were extracted into evidence tables, and the evidence was synthesized according to the modified SIGN criteria.Conclusion: The results of this study form the basis for a better understanding of recovery after MTBI, and will allow development of prediction tools and recommendation of interventions, as well as informing health policy and setting a future research agenda.
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| 2. |
- Geijerstam, Jean-Luc af
(författare)
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Mild head injury : inhospital observation or computed tomography?
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Patients with mild head injuries are treated every day in emergency departments around the world. The rationale for any management strategy is to identify with a high degree of safety at reasonable costs, patients at risk of deterioration due to serious intracranial injuries. Traditionally, management has been based on admission for inhospital observation. Recently, computed tomography (CT) imaging for patients with mild head injury has increased. This investigation has often been added to inhospital observation, raising the question whether it would be possible to use CT to triage patients for admission. Thereby, fewer patients would be admitted; those with complications would be detected sooner; and resources would be put to better use in emergency care. Aim: To compare CT imaging in triage for admission with inhospital observation - in terms of patient outcome, safety, costs, and feasibility - in managing patients with mild head injury. Methods: In an initial study, the current clinical practise for acute care of patients with mild head injury in Sweden was surveyed. A second study examined the mortality and frequency of complications in patients with mild head injury, in a systematic literature review including a meta-analysis of the findings. The third study assessed the costs of the two strategies of care, by means of a systematic literature review and a decision analysis based on the findings of the meta-analysis. Finally, a pragmatic, multicenter randomised controlled trial (RCT) was conducted to assess patient outcome, and the feasibility and safety of the two strategies. Results: Patients with mild head injury are routinely admitted for inhospital observation in Sweden, with about 20% also undergoing CT imaging. The literature review identified and critically assessed representative series including 24 000 patients. Based on a metaanalysis of their results, it was estimated that: of 1 000 patients arriving at hospital with mild head injury, 1 will die, 9 will require surgery or other intervention and 80 will have pathological findings on CT. In the decision analysis and literature review it was found that the costs of the CT-strategy was one third lower and might save inhospital bed days for other patients. The RCT randomised 2 602 patients to either CT imaging or inhospital observation. Patient outcome at 3-months was not inferior for the CT strategy compared to inhospital observation, None of the patients with normal findings on the acute CT scan later suffered complications. Conclusions: The results of the three initial studies were confirmed in the large RCT. Thus, the use of CT imaging to triage for admission is a safe and feasible management strategy for patients with mild head injury. The CT strategy reduces costs by one third, and is not inferior for patient outcome compared to inhospital observation.
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| 3. |
- Jacobsson, Lars, et al.
(författare)
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ADHD : Diagnostik och behandling, vårdens organisation och patientens delaktigheten systematisk litteraturöversikt
- 2013
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Rapport (refereegranskat)abstract
- ADHD En funktionsnedsättning med debut i baranåren. Kärmsymtom karaktäriseras av uppmärksamhetsproblem, impulsivitet ioch hyperaktivitet.I ett antal fall sker en normalisering eller mognadsprocess, i andra fall kan någon form av psykisk ohälsa förekommma samtidigt. Den diagnostiska utredningen är omfattande, och både instrument för diagnostik och den diagnostiska processen bör undersökas bättre.Många olika insatser och behandlingar, förutom läkemedel förekommer idag, men kunskapen om eras nytta, risker och kostnader måste förbättras. Vissa läkemedel lindrar ADHD symtom vid korttidsbehandling, men nyttan av långtidsbehandling går inte att bedöma. Vanliga biverjkningar av dessa läkemedel är illamående och nedsatt aptit, för barn viktminskning och pulsökning.
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| 4. |
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| 5. |
- Lannsjö, Marianne, et al.
(författare)
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Prevalence and structure of symptoms at 3 months after mild traumatic brain injury in a national cohort
- 2009
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Ingår i: Brain Injury. - : Informa UK Limited. - 0269-9052 .- 1362-301X. ; 23:3, s. 213-219
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES To describe symptom prevalence and structure after mild traumatic brain injury (MTBI) in a population-based cohort. METHODS Symptoms data were collected at 3 months post-MTBI by use of the Rivermead Post-concussion Symptoms Questionnaire (RPQ) at follow-up of 2602 patients attending 39 Swedish hospitals. Spearmans rank correlation analysis was used to explore correlations between symptoms and structural equation modelling (SEM) was performed by use of several fit indices to explore if data were compatible with one or more factors. RESULTS Questionnaires were received from 2523 (97%) patients with a mean age of 31 years (median 22, range 6-96). A majority of the respondents (56%) reported no remaining injury related symptoms, 24% reported three or more symptoms and 10% reported seven or more symptoms. All symptoms exhibited strong positive inter-relations and SEM provided strong support for a single or two factor solution. Fit indices were only slightly weaker for three and four factor solutions. CONCLUSIONS A significant minority of patients reported multiple symptoms to persist at 3 months after MTBI. The observed structure of symptoms according to RPQ demonstrates a common factor for all symptoms, but also sub-groups of symptoms as previously suggested.
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| 6. |
- Nygren de Boussard, Catharina, et al.
(författare)
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Delayed Intracranial Complications After Concussion
- 2006
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Ingår i: Journal of Trauma. - : Ovid Technologies (Wolters Kluwer Health). - 0022-5282 .- 1529-8809. ; 61:3, s. 577-581
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Tidskriftsartikel (refereegranskat)abstract
- Background and Methods: The incidence of readmissions because of delayed intracranial complications within 3 weeks after observation for the sole diagnosis of concussion was examined in a national cohort. A nested case-control design was used to analyze the association between clinical factors as well as early computed tomography (CT) scan examination and these complications. Results: Out of 100,784 patients hospitalized because of concussion during ten years, 127 (0.13%) patients were readmitted because of a delayed intracranial complication. High clinical severity grade (odds ratio [OR] 2.0, confidence interval [CI] 1.2-3.6), minor CT scan abnormalities (OR 1.7, CI 0.8-3.4) and male gender (OR 2.2, CI 1.4-3.5) were associated with an increased risk of delayed, intracranial complications. Conclusion: The incidence of delayed intracranial complications after primarily uncomplicated concussion was low. High clinical severity grade and male gender were risk factors. We failed to demonstrate an additional value of the acute CT scan examination to predict these complications.
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