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  • 1. Borg, Jörgen
    et al.
    Holm, Lena
    Cassidy, J David
    Peloso, Paul M.
    Carroll, Linda J.
    von Holst, Hans
    Department of Neurosurgery, Karolinska Institutet, Stockholm, Sweden.
    Ericson, Kaj
    Diagnostic procedures in mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury2004In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 36, no 43, p. 61-75Article in journal (Refereed)
    Abstract [en]

    We examined diagnostic procedures in mild traumatic brain injury by a systematic literature search. After screening 38,806 abstracts, we critically reviewed 228 diagnostic studies and accepted 73 (32%). The estimated prevalence of intracranial CT scan abnormalities is 5% in patients presenting to hospital with a Glasgow Coma Scale score of 15 and 30% or higher in patients presenting with a score of 13. About 1% of all treated patients with mild traumatic brain injury require neurosurgical intervention. There is strong evidence that clinical factors can predict computerized tomography scan abnormalities and the need for intervention in adults, but no such evidence for mild traumatic brain injury in children. We found evidence that skull fracture is a risk factor for intracranial lesions, but the diagnostic accuracy of radiologically diagnosed skull fracture as an indication of intracranial lesions is poor. There is only a little evidence for the diagnostic validity of cognitive testing and other diagnostic tools for mild traumatic brain injury.

  • 2. Borg, Jörgen
    et al.
    Holm, Lena
    Peloso, Paul M.
    Cassidy, J. David
    Carroll, Linda J.
    von Holst, Hans
    Department of Neurosurgery, Karolinska Institutet, Stockholm, Sweden.
    Paniak, Chris
    Yates, David
    Non-surgical intervention and cost for mild traumatic brain injury: results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury2004In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 36, no 43, p. 76-83Article in journal (Refereed)
    Abstract [en]

    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.

  • 3. Börsbo, Björn
    et al.
    Peolsson, Michael
    KTH, School of Technology and Health (STH), Centres, Centre for Technology in Medicine and Health, CTMH.
    Gerdle, Björn
    Catastrophizing, depression, and pain: Correlation with and influence on quality of life and health - A study of chronic whiplash-associated disorders2008In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, no 7, p. 562-569Article in journal (Refereed)
    Abstract [en]

    Objective: The aims of this study were: (i) to classify subgroups according to the degree of pain intensity, depression, and catastrophizing, and investigate distribution in a group of patients with chronic whiplash-associated disorders; and (h) to investigate how these subgroups were distributed and inter-related multivariately with respect to consequences such as health and quality of life outcome measures. Design: Descriptive cross-sectional study. Patients: A total of 275 consecutive chronic pain patients with whiplash-associated disorders who were referred to a university hospital. Methods: The following data were obtained by means of self-report questionnaires: pain intensity in neck and shoulders, background history, Beck Depression Inventory, the catastrophizing scale of Coping Strategy Questionnaire, Life Satisfaction Checklist, the SF-36 Health Survey, and the EuroQol. Results: Principal component analysis was used to recognize subgroups according to the degree of pain intensity, depression, and catastrophizing. These subgroups have specific characteristics according to perceived health and quality of life, and the degree of depression appears to be the most important influencing factor. Conclusion: From a clinical point of view, these findings indicate that it is important to assess patients for intensity of pain, depression, and catastrophizing when planning a rehabilitation programme. Such an evaluation will help individualize therapy and intervention techniques so as to optimize the efficiency of the programme.

  • 4. Carroll, L. J.
    et al.
    Cassidy, J. D.
    Peloso, P. M.
    Borg, J.
    von Holst, Hans
    KTH, Superseded Departments, Aeronautical and Vehicle Engineering.
    Holm, L.
    Paniak, C.
    Pepin, M.
    Prognosis for mild traumatic brain injury: Results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury2004In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 36, p. 84-105Article, review/survey (Refereed)
    Abstract [en]

    We searched the literature on the epidemiology, diagnosis, prognosis, treatment and costs of mild traumatic brain injury. Of 428 studies related to prognosis after mild traumatic brain injury, 120 (28%) were accepted after critical review. These comprise our best-evidence synthesis on prognosis after mild traumatic brain injury. There was consistent and methodologically sound evidence that children's prognosis after mild traumatic brain injury is good, with quick resolution of symptoms and little evidence of residual cognitive, behavioural or academic deficits. For adults, cognitive deficits and symptoms are common in the acute stage, and the majority of studies report recovery for most within 3-12 months. Where symptoms persist, compensation/litigation is a factor, but there is little consistent evidence for other predictors. The literature on this area is of varying quality and causal inferences are often mistakenly drawn from cross-sectional studies.

  • 5.
    Cassidy, David J.
    et al.
    Alberta Centre for Injury Control and Research, Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada, Section for Personal Injury Prevention, Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden.
    Carrol, Linda J.
    Alberta Centre for Injury Control and Research, Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
    Peloso, Paul M.
    Department of Internal Medicine, University of Iowa Health Center, Iowa City, Iowa, USA.
    Borg, Jörgen
    Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden.
    von Holst, Hans
    Department of Neurosurgery, Karolinska Institutet, Stockholm, Sweden.
    Holm, Lena
    Section for Personal Injury Prevention, Department of Clinical Neurosciences, Karolinska Institutet, Stockholm, Sweden.
    Kraus, Jess
    Division of Epidemiology, School of Public Health, University of California, Los Angeles, California, USA.
    Coronado, Victor G.
    National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
    Incidence, risk factors and prevention of mild traumatic brain injury: Results of the WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury2004In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 36, no 43, p. 28-60Article in journal (Refereed)
    Abstract [en]

    Objective: We undertook a best-evidence synthesis on the incidence, risk factors and prevention of mild traumatic brain injury. Methods: Medline, Cinahl, PsycINFO and Embase were searched for relevant articles. After screening 38,806 abstracts, we critically reviewed 169 studies on incidence, risk and prevention, and accepted 121 (72%).Results: The accepted articles show that 70–90% of all treated brain injuries are mild, and the incidence of hospital- treated patients with mild traumatic brain injury is about 100–300/100,000 population. However, much mild traumatic brain injury is not treated at hospitals, and the true population-based rate is probably above 600/100,000. Mild traumatic brain injury is more common in males and in teenagers and young adults. Falls and motor-vehicle colli- sions are common causes.Conclusion: Strong evidence supports helmet use to prevent mild traumatic brain injury in motorcyclists and bicyclists. The mild traumatic brain injury literature is of varying quality, and the studies are very heterogeneous. Never- theless, there is evidence that mild traumatic brain injury is an important public health problem, but we need more high- quality research into this area.

  • 6. Cassidy, David J.
    et al.
    von Holst, Hans
    KTH, Superseded Departments, Aeronautical and Vehicle Engineering.
    Best evidence synthesis on Mild Traumatic Brain Injury: Results of the WHO collaborating centre for neurotrauma prevention, management and rehabilitation task force on Mild Traumatic Brain Injury2004In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. Feb, no Supplement 43, p. 1-144Article in journal (Refereed)
  • 7. Peloso, Paul M
    et al.
    Carroll, Linda J
    Cassidy, J David
    Borg, Jörgen
    von Holst, Hans
    KTH, School of Technology and Health (STH), Neuronic Engineering.
    Holm, Lena
    Yates, David
    Critical evaluation of the existing guidelines on mild traumatic brain injury.2004In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, no 43 Suppl, p. 106-12Article in journal (Refereed)
    Abstract [en]

    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.

  • 8.
    Peloso, Paul M.
    et al.
    Department of Internal Medicine, University of Iowa Health Center, Iowa City, Iowa, USA.
    von Holst, Hans
    Department of Neurosurgery, Karolinska Institutet, Stockholm, Sweden.
    Borg, Jörgen
    Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden.
    Mild traumatic brain injuries presenting to Swedish hospitals in 1987-20002004In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 36, no 43, p. 22-27Article in journal (Refereed)
    Abstract [en]

    Objective: To evaluate the incidence and causes of mild traumatic brain injury in Sweden.Design: Retrospective, population-based incidence cohort study.Subjects: All persons presenting to hospitals in Sweden between 1987 and 2000 with a discharge diagnosis of ICD-9 code 850 and ICD-10 code S0.60.Methods: Data source was the Hospital Discharge Register at the National Board of Health and Welfare (Sweden). Incidence rates are stratified by age, gender, mechanism of injury and length of hospital stay.Results: Men had a mean of 209 mild traumatic brain injuries per 100,000 inhabitants and women averaged 148 per 100,000. Men had more mild traumatic brain injury than women at all ages. There were 2 incidence peaks, in the age strata 16-20 years and those over 65 years. Falls were the most common cause of mild traumatic brain injury overall and occurred commonly under the age of 10 years and over the age of 65 years. Motor vehicle and bicycle injuries were the second and third most common causes of mild traumatic brain injury, and had their peak incidence in those aged 16-35 years.Conclusion: Preventative strategies for mild traumatic brain injury should be age and gender specific.

  • 9. Peolsson, Michael
    et al.
    Börsbo, Björn
    Gerdle, Björn
    Generalized pain is associated with more negative consequences than local or regional pain: A study of chronic whiplash-associated disorders2007In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 39, no 3, p. 260-268Article in journal (Refereed)
    Abstract [en]

    Objective: The main aims of this study were: (i) to determine, for chronic whiplash-associated disorders, whether widespread pain has more severe consequences for other symptoms and different aspects of perceived health than does local/regional pain; (ii) to investigate whether pain, depression, and symptoms not directly related to pain are intercorrelated and to what extent these symptoms correlate with catastrophizing according to the Coping Strategy Questionnaire. Design: Descriptive cross-sectional study. Patients: A total of 275 consecutive chronic pain patients with whiplash-associated disorders who were referred to a university hospital. Methods: Background history, Beck Depression Inventory, Coping Strategy Questionnaire, Life Satisfaction Checklist, the SF-36 Health Survey and EuroQol were used to collect data. Results: Spreading of pain was associated with negative consequences with respect to pain intensity and prevalence of other symptoms, life satisfaction/quality and general health. The subjects differ with respect to the presence of symptoms not directly related to pain. A minor part of the variation in Back Depression Inventory was explained by direct aspects of pain, indicating that, to some extent, generalization of pain is related to catastrophizing thoughts. Conclusion: Widespread pain was associated with negative consequences with respect to pain intensity, prevalence of other symptoms including depressive symptoms, some aspects of coping, life satisfaction and general health.

  • 10. Peolsson, Michael
    et al.
    Gerdle, Björn
    Coping in patients with chronic whiplash-associated disorders: A descriptive study2004In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 36, no 1, p. 28-35Article in journal (Refereed)
    Abstract [en]

    Objective: There are few studies of the way patients with chronic whiplash-associated disorders cope with pain and other aspects of the condition. This study analyses: (a) gender differences in coping strategies; (b) whether the patients can be sub-grouped based on their coping strategies and whether the sub-groups differ clinically; and

  • 11.
    von Holst, Hans
    et al.
    KTH.
    Cassidy, J. David
    Mandate of the who collaborating centre task force on mild traumatic brain injury2004In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 36, p. 8-10Article in journal (Refereed)
    Abstract [en]

    In collaboration with outside experts, the WHO Collaborating Centre for Neurotrauma at the Karolinska Institute, Stockholm, Sweden, has assembled a task force to undertake a best-evidence synthesis of the literature on mild traumatic brain injury. The task force has addressed the epidemiology, diagnosis, prognosis, treatment and economic costs of mild traumatic brain injury in order to make recommendations to reduce the medical as well as the social consequences of mild traumatic brain injury.

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