Prognos e)er lä, trauma1sk hjärnskada

Transcription

1 Prognos e)er lä, trauma1sk hjärnskada

2 Results of the Interna1onal Collabora1on on Mild Trauma1c Brain Injury Prognosis (ICoMP) Systema1c review of the literature Uppdate of a previous systema1c review 2002 Prognosis for mild trauma1c brain injury: results of the WHO Collabora1ng Centre Task Force on Mild Trauma1c Brain Injury, Carroll LJ, et al, WHO Collabora1ng Centre Task Force on Mild Trauma1c Brain Injury Authors from Sweden, Denmark, Canada, USA From Sweden: Jörgen Borg, Catharina Nygren- deboussard, Alison Godbolt, Lena Holm, Bri,- Marie Stålnacke, Jean- Luc af Giejerstam

3 Methods Published protocol before study start Search Strategy Detailed inclusion and exclusion criteria Publica1on date, Language, Publica1on type, Study design, Study popula1on, Case Defini1on, Outcomes Clearly defined methods for assessment of studies S I G N Methodology Checklist 3: Cohort studies

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6 Reviews on many aspects of prognosis a)er mild trauma1c brain injury Self- reported Prognosis Cogni1ve, Psychiatric and Mortality Outcomes Prognosis for children Psychosocial consequences Return to work Return to play (sports) Mild TBI in the military Mild TBI and risk for Parkinson s disease Mild TBI and risk for demen1a and chronic cogni1ve impairment Nonsurgical interven1ons for mild TBI Methodological issues and research recommenda1ons

7 Reviews on many aspects of prognosis a)er mild trauma1c brain injury Self- reported Prognosis Cogni1ve, Psychiatric and Mortality Outcomes Prognosis for children Psychosocial consequences Return to work Return to play (sports) Mild TBI in the military Mild TBI and risk for Parkinson s disease Mild TBI and risk for demen1a and chronic cogni1ve impairment Nonsurgical interven1ons for mild TBI Methodological issues and research recommenda1ons

8 Self- reported prognosis 23 accepted studies Common postconcussion symptoms are not specific to mild TBI / concussion occur a)er other non- head injuries Poor recovery associated with More injury- related stress Poorer premorbid mental and physical health Most recover over 1 year But persistent symptoms more likely with more acute symptoms and more emo1onal stress

9 Objec1ve outcomes: Cogni1ve, Psychiatric and Mortality 21 accepted studies Most evidence for Cogni1ve deficits in the first 2 weeks Some evidence that Complete recovery may take 6 months or a year A li0le evidence that Mild TBI increases risk of psychiatric illness and suicide

10 Risk of demen1a a)er mild TBI: only one methodologically acceptable study Helmes E, et al, Brain Inj 2011;25: history of mild TBI was not associated with a future diagnosis of demen1a or with other cogni1ve outcomes. insufficient evidence to draw any conclusion about a poten1al risk of demen1a a)er mild TBI (either single or repe11ve injury).

11 Risk of chronic cogni1ve impairment a)er mild TBI Defini1on: Cogni1ve impairment at 1 year No studies in adults 6 studies in children

12 Risk of chronic cogni1ve impairment a)er mild TBI no evidence of cogni1ve impairment (neuropsych) 1 year a)er injury in school- aged children with MTBI and normal MRI children with abnormal MRI had worse cogni1on a year a)er injury than those with normal MRI Mixed evidence regarding chronic cogni1ve symptoms

13 Nonsurgical interven1ons for mild TBI 7 studier 8 publika1oner handlade om interven1on och MTBI 2 studier (RCTs) accepterades: Förfa'are Interven-on Kontroll grupp Uppföljning Resultat Bell et al, 2008 Telefonkontakt, 3 mån e)er skadan + skri)lig info Vanligt infoblad 6 mån - Färre symtom i interven1onsgrupp - dock ingen påverkan på generell hälsa De Kruijk et al, dagars sängläge Begränsad sängläge 2v, 3 och 6 mån - ingen signifikant skillnad avseende symtom eller livs1llfredssällelse vid tre månader eller 6 månader. October 13,

14 RCT Faktorer a, beakta i studier avseende interven1on Tydligt beskriva randomisering, drop- out Predik1onsmodeller Fokus på behandlingsbara prognos1ska faktorer October 13,

15 Tack!