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Published Online: 7 April 2015

Systematic Review of Multivariable Prognostic Models for Mild Traumatic Brain Injury

Publication: Journal of Neurotrauma
Volume 32, Issue Number 8

Abstract

Prognostic models can guide clinical management and increase statistical power in clinical trials. The availability and adequacy of prognostic models for mild traumatic brain injury (MTBI) is uncertain. The present study aimed to (1) identify and evaluate multivariable prognostic models for MTBI, and (2) determine which pre-, peri-, and early post-injury variables have independent prognostic value in the context of multivariable models. An electronic search of MEDLINE, PsycINFO, PubMed, EMBASE, and CINAHL databases for English-language MTBI cohort studies from 1970–2013 was supplemented by Web of Science citation and hand searching. This search strategy identified 7789 articles after removing duplicates. Of 182 full-text articles reviewed, 26 met eligibility criteria including (1) prospective inception cohort design, (2) prognostic information collected within 1 month post-injury, and (3) 2+variables combined to predict clinical outcome (e.g., post-concussion syndrome) at least 1 month later. Independent reviewers extracted sample characteristics, study design features, clinical outcome variables, predictor selection methods, and prognostic model discrimination, calibration, and cross-validation. These data elements were synthesized qualitatively. The present review found no multivariable prognostic model that adequately predicts individual patient outcomes from MTBI. Suboptimal methodology limits their reproducibility and clinical usefulness. The most robust prognostic factors in the context of multivariable models were pre-injury mental health and early post-injury neuropsychological functioning. Women and adults with early post-injury anxiety also have worse prognoses. Relative to these factors, the severity of MTBI had little long-term prognostic value. Future prognostic studies should consider a broad range of biopsychosocial predictors in large inception cohorts.

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cover image Journal of Neurotrauma
Journal of Neurotrauma
Volume 32Issue Number 8April 15, 2015
Pages: 517 - 526
PubMed: 25222514

History

Published in print: April 15, 2015
Published online: 7 April 2015
Published ahead of print: 13 January 2015
Published ahead of production: 15 September 2014

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Noah D. Silverberg
University of British Columbia and GF Strong Rehab Centre, Vancouver, British Columbia, Canada.
Andrew J. Gardner
Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, University of Newcastle, Waratah, New South Wales, Australia.
Jeffrey R. Brubacher
Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
William J. Panenka
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
Jun Jian Li
Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
Grant L. Iverson
Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; Massachusetts General Hospital Sport Concussion Clinic; and Red Sox Foundation and Massachusetts General Hospital Home Base Program, Charlestown, Massachusetts.

Notes

Address correspondence to:Noah D. Silverberg, PhDUniversity of British Columbia and GF Strong Rehab Centre4255 Laurel StreetVancouver, British Columbia, V5Z 2G9Canada
E-mail: [email protected]

Author Disclosure Statement

Andrew Gardner has a clinical practice in neuropsychology involving persons who have sustained sports-related concussion (including current and former athletes). He has received travel funding from the Australian Football League (AFL) to present at the Concussion in Football Conference in 2013. Previous grant funding includes the NSW Sporting Injuries Committee, the Brain Foundation, and the Hunter Medical Research Institute, supported by Jennie Thomas.
Grant Iverson, Ph.D. has been reimbursed by the government, professional scientific bodies, and commercial organizations for discussing or presenting research relating to mild TBI and sport-related concussion at meetings, scientific conferences, and symposiums. He has a clinical and consulting practice in forensic neuropsychology involving persons who have sustained mild TBIs. He has received research funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc.). He is a co-investigator, collaborator, or consultant on grants relating to mild TBI funded by several organizations, including, but not limited to, the Canadian Institute of Health Research, Alcohol Beverage Medical Research Council, Rehabilitation Research and Development (RR&D) Service of the US Department of Veterans Affairs, Vancouver Coastal Health Research Institute, and Roche Diagnostics Canada.
For the remaining authors, no competing financial interests exist.

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