Concussion Guidelines Step 2: Evidence for Subtype Classification

Abstract BACKGROUND Concussion is a heterogeneous mild traumatic brain injury (mTBI) characterized by a variety of symptoms, clinical presentations, and recovery trajectories. By thematically classifying the most common concussive clinical presentations into concussion subtypes (cognitive, ocular-motor, headache/migraine, vestibular, and anxiety/mood) and associated conditions (cervical strain and sleep disturbance), we derive useful definitions amenable to future targeted treatments. OBJECTIVE To use evidence-based methodology to characterize the 5 concussion subtypes and 2 associated conditions and report their prevalence in acute concussion patients as compared to baseline or controls within 3 d of injury. METHODS A multidisciplinary expert workgroup was established to define the most common concussion subtypes and their associated conditions and select clinical questions related to prevalence and recovery. A literature search was conducted from January 1, 1990 to November 1, 2017. Two experts abstracted study characteristics and results independently for each article selected for inclusion. A third expert adjudicated disagreements. Separate meta-analyses were conducted to do the following: 1) examine the prevalence of each subtype/associated condition in concussion patients using a proportion, 2) assess subtype/associated conditions in concussion compared to baseline/uninjured controls using a prevalence ratio, and 3) compare the differences in symptom scores between concussion subtypes and uninjured/baseline controls using a standardized mean difference (SMD). RESULTS The most prevalent concussion subtypes for pediatric and adult populations were headache/migraine (0.52; 95% CI = 0.37, 0.67) and cognitive (0.40; 95% CI = 0.25, 0.55), respectively. In pediatric patients, the prevalence of the vestibular subtype was also high (0.50; 95% CI = 0.40, 0.60). Adult patients were 4.4, 2.9, and 1.7 times more likely to demonstrate cognitive, vestibular, and anxiety/mood subtypes, respectively, as compared with their controls (P < .05). Children and adults with concussion showed significantly more cognitive symptoms than their respective controls (SMD = 0.66 and 0.24; P < .001). Furthermore, ocular-motor in adult patients (SMD = 0.72; P < .001) and vestibular symptoms in both pediatric and adult patients (SMD = 0.18 and 0.36; P < .05) were significantly worse in concussion patients than in controls. CONCLUSION Five concussion subtypes with varying prevalence within 3 d following injury are commonly seen clinically and identifiable upon systematic literature review. Sleep disturbance, a concussion-associated condition, is also common. There was insufficient information available for analysis of cervical strain. A comprehensive acute concussion assessment defines and characterizes the injury and, therefore, should incorporate evaluations of all 5 subtypes and associated conditions.

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Students’ preparedness for disasters in schools: a systematic review protocol

BMJ Paediatrics Open ◽

10.1136/bmjpo-2020-000913 ◽

2020 ◽

Vol 4 (1) ◽

pp. e000913

Author(s):

Hamed Seddighi ◽

Homeira Sajjadi ◽

Sepideh Yousefzadeh ◽

Mónica López López ◽

Meroe Vameghi ◽

...

Keyword(s):

Systematic Review ◽

Systematic Reviews ◽

Disaster Preparedness ◽

Vulnerable Groups ◽

Narrative Synthesis ◽

Ethics Code ◽

Study Characteristics ◽

And Gender ◽

Critical Appraisal Skills ◽

Meta Analyses

IntroductionChildren are one of the most vulnerable groups in disasters. Improving students’ knowledge and skills to prepare for disasters can play a major role in children’s health. School as a place to teach children can make a significant contribution to provide the necessary skills. This study aims to identify the effects, strengths and weaknesses of interventions in schools to prepare children for disasters.Methods and analysisWe use Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to develop a protocol for this systematic review. The included studies will report on the results of interventions targeting ‘schoolchildren’ defined as individuals between 4 and under 18 years old studying in schools. Different electronic databases will be used for a comprehensive literature search, including MEDLINE, Web of Science, CINAHL, PsycINFO, Cochrane Register of Controlled Trials and EMBASE to identify the records that match the mentioned inclusion criteria published till December 2020. The main search terms are ‘disaster’, ‘preparedness’, ‘children’ and ‘school’. Four types of data will be extracted from the qualified studies including study characteristics (study design, year of publication and geographical region where the study was conducted), participant characteristics (sample size, age and gender), intervention characteristics (aim of intervention, intervention facilitators and barriers) and intervention outcomes. The quality appraisal of the selected papers will be conducted using Cochrane Collaboration’s Risk of Bias for quantitative studies and Critical Appraisal Skills Programme checklist for qualitative studies. We use a narrative synthesis for this systematic review. The narrative synthesis refers to an approach to systematic reviews which focuses mostly on applying words and texts to summarise and explain findings.Ethics and disseminationThis paper is a part of a Ph.D. thesis of Hamed Seddighi at University of Social welfare and Rehabilitation Sciences with ethics code IR.USWR.REC.1399.008 approved by the Ethics Committee of the above-mentioned university.PROSPERO registration numberCRD42020146536.

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Internal jugular phlebectasia: A systematic review

Surgical Neurology International ◽

10.25259/sni-217-2019 ◽

2019 ◽

Vol 10 ◽

pp. 106 ◽

Cited By ~ 4

Author(s):

Jose A. Figueroa-Sanchez ◽

Ana S. Ferrigno ◽

Mario Benvenutti-Regato ◽

Enrique Caro-Osorio ◽

Hector R. Martinez

Keyword(s):

Systematic Review ◽

Natural History ◽

Conservative Treatment ◽

Literature Search ◽

Jugular Vein ◽

Adult Patients ◽

Therapeutic Approaches ◽

Jugular Phlebectasia ◽

The Right ◽

Meta Analyses

Background: Internal jugular phlebectasia (IJP), the abnormal dilatation of internal jugular vein, is generally considered a benign anomaly. However, because IJP is uncommon, little is known about its natural history, and currently, no consensus on the best treatment modality is available. Methods: The purpose of this article is to conduct a systematic review of available literature on recently reported IJP cases to understand the main characteristics of IJP and its most frequent therapeutic approaches. Following the preferred reporting items for systematic reviews and meta-analyses guidelines, literature search for IJP cases was conducted in the COCHRANE, PUBMED, EBSCOHOST, SCOPUS, OVID, and SCIELO databases. Results: A total of 97 original articles were found, with a total of 247 IJP cases reported including both pediatric and adult patients. Conclusions: To the best of our knowledge, this study is the largest systematic review analyzing all the reported cases of IJP. IJP is considered by most authors as a benign abnormality that predominantly affects the right jugular vein. It is most commonly diagnosed in children. At present, conservative treatment is preferred for pediatric but not for adult patients. Multicenter randomized prospective studies are required to further understand this rare anomaly.

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Efficacy of medications in adult patients with trigeminal neuralgia compared to placebo intervention: a systematic review with meta-analyses

Journal of Dental Anesthesia and Pain Medicine ◽

10.17245/jdapm.2021.21.5.379 ◽

2021 ◽

Vol 21 (5) ◽

pp. 379

Author(s):

Georgia M. Peterson-Houle ◽

Magda R. AbdelFattah ◽

Mariela Padilla ◽

Reyes Enciso

Keyword(s):

Systematic Review ◽

Trigeminal Neuralgia ◽

Adult Patients ◽

Placebo Intervention ◽

Meta Analyses

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Systematic review and meta-analyses of trendelenburg and prone position on intraocular pressure in adult patients undergoing surgery

10.32469/10355/70033 ◽

2019 ◽

Author(s):

◽

Sharon Ann Van Wicklin

Keyword(s):

Intraocular Pressure ◽

Prone Position ◽

Vision Loss ◽

Meta Analysis ◽

Adult Patients ◽

Trendelenburg Position ◽

Time Points ◽

Comprehensive Search ◽

Meta Analyses ◽

Difference Effect

Background. Patients undergoing surgery in the Trendelenburg and prone positions may be at risk for postoperative vision loss associated with increased intraocular pressure. The purpose of this dissertation research is to estimate the magnitude of the increase in intraocular pressure at specific perioperative time points in adult patients undergoing surgery in the Trendelenburg and prone positions. Methods. Comprehensive search strategies were used to identify eligible studies for two meta-analyses and to address the research questions. For each meta-analysis, standardized mean difference effect sizes were calculated for selected perioperative time points. Results. Using a random effects model, the meta-analysis examining the effect of Trendelenburg position, showed that intraocular pressure decreased significantly after induction and before arousal. Intraocular pressure increased significantly after abdominal insufflation and during Trendelenburg position. The meta-analysis examining the effect of prone position, showed that intraocular pressure increased significantly between induction of anesthesia and up to 10 minutes of prone position and continued to increase significantly until the end of the prone position. Conclusions. Intraocular pressure increases of the magnitude found in this research demonstrate the need for implementing interventions to reduce the risk for postoperative vision loss in patients undergoing surgery in the Trendelenburg and prone positions.

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Association between sleep quality and self-care in adults with heart failure: A systematic review

European Journal of Cardiovascular Nursing ◽

10.1177/1474515120941368 ◽

2020 ◽

pp. 147451512094136 ◽

Cited By ~ 1

Author(s):

Valentina Spedale ◽

Michela Luciani ◽

Alessandro Attanasio ◽

Stefania Di Mauro ◽

Rosaria Alvaro ◽

...

Keyword(s):

Heart Failure ◽

Systematic Review ◽

Medication Adherence ◽

Sleep Quality ◽

Sleep Disturbance ◽

Self Care ◽

The Other ◽

Heart Failure Patients ◽

Meta Analyses

Background: Sleep disturbance is one of the most common symptoms among heart failure patients. Sleep disturbance reduces quality of life and leads to higher rates of mortality. It may affect the ability of patients to perform adequate self-care. Although some research has evaluated the association between sleep quality and heart failure self-care, a synthesis of the most recent available evidence is lacking. Aims: This systematic review aimed to assess the association between sleep quality and self-care in adults with heart failure. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology was used. Medline, CINAHL, PsycINFO and SCOPUS were searched. Observational, case-control and cohort studies were considered. The quality of the studies was evaluated with the Joanna Briggs Institute’s Critical Appraisal Tools. Results: Six articles were included. Association between sleep quality and self-care was reported by three studies. One of these did not find an association between sleep disturbance and heart failure self-care, while the other two studies did. An association between sleep quality and medication adherence was reported by three studies. All three of these studies found associations between these two variables. Studies have measured similar but different constructs. Two studies assessed sleep quality, while four other studies measured excessive daytime sleepiness. Half of the studies examined self-care, while the other half measured medication adherence. Conclusions: Although the evidence should be strengthened, sleep quality seems to affect self-care in heart failure patients. The mechanism underlying the effect of sleep quality on heart failure self-care remains unclear. Future longitudinal interaction analyses could be useful to clarify this mechanism.

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Prevalence of extra-articular manifestations in psoriatic arthritis: a systematic review and meta-analysis

Rheumatology ◽

10.1093/rheumatology/keaa062 ◽

2020 ◽

Vol 59 (9) ◽

pp. 2199-2206 ◽

Cited By ~ 4

Author(s):

Bradley Pittam ◽

Sonal Gupta ◽

Nicholas L Harrison ◽

Selina Robertson ◽

David M Hughes ◽

...

Keyword(s):

Radiographic Progression ◽

Meta Analysis ◽

Response To Treatment ◽

Disease Outcomes ◽

Disease Mechanisms ◽

Prevalence Estimates ◽

Study Characteristics ◽

Meta Analyses ◽

The Impact ◽

Nail Disease

Abstract Objective To describe the prevalence of extra-articular manifestations—enthesitis, dactylitis, nail disease, uveitis and IBD—in PsA, and their impact on longitudinal disease outcomes. Methods We searched Medline, PubMed, Scopus and Web of Science using a predefined protocol in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies using imaging to define extra-articular manifestations (EAMs) were excluded. Where possible, we performed meta-analyses of prevalence estimates, reported as percentages (95% CI). Heterogeneity (I2 statistic) was examined according to study characteristics. Results We identified 65 studies amounting to a total of 163 299 PsA patients. Enthesitis was assessed in 29 studies with an average prevalence of 30% (95% CI: 24%, 38%). Dactylitis was reported in 35 studies with an average prevalence of 25% (95% CI: 20%, 31%). Nail disease was present in 60% (95% CI: 52%, 68%) across 26 studies, but definitions were often unclear. Uveitis (3.2%; 95% CI: 1.9%, 5.3%) and IBD (3.3%; 95% CI: 1.5%, 7.1%) were less common. Heterogeneity was high (>95%) in all meta-analyses, but could not be explained by study characteristics. No studies examined the impact of EAMs on longitudinal disease outcomes, except that dactylitis increases radiographic progression. Conclusion Enthesitis, dactylitis and nail disease are highly prevalent in PsA, but not uveitis and IBD. EAM patterns differ from axial SpA despite their shared disease mechanisms, which may help further understand differences between spondyloarthritides. More studies are needed on the impact of EAMs on disease outcomes such as response to treatment.

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Intravenous Lipid Emulsions to Deliver Bioactive Omega-3 Fatty Acids for Improved Patient Outcomes

Marine Drugs ◽

10.3390/md17050274 ◽

2019 ◽

Vol 17 (5) ◽

pp. 274 ◽

Cited By ~ 11

Author(s):

Philip C. Calder

Keyword(s):

Fatty Acids ◽

Parenteral Nutrition ◽

Fish Oil ◽

Hospital Stay ◽

Critically Ill ◽

Adult Patients ◽

Lipid Emulsions ◽

Omega 3 Fatty Acids ◽

Omega 3 ◽

Meta Analyses

Lipids used in intravenous nutrition support (i.e., parenteral nutrition) provide energy, building blocks, and essential fatty acids. These lipids are included as emulsions since they need to be soluble in an aqueous environment. Fish oil is a source of bioactive omega-3 fatty acids (eicosapentaenoic acid and docosahexaenoic acid). Lipid emulsions, including fish oil, have been used for parenteral nutrition for adult patients post-surgery (mainly gastrointestinal). This has been associated with alterations in biomarkers of inflammation and immune defense, and in some studies, a reduction in length of intensive care unit and hospital stay. These benefits, along with a reduction in infections, are emphasized through recent meta-analyses. Perioperative administration of fish oil may be superior to postoperative administration, but this requires further exploration. Parenteral fish oil has been used in critically ill adult patients. Here, the influence on inflammatory processes, immune function, and clinical endpoints is less clear. However, some studies found reduced inflammation, improved gas exchange, and shorter length of hospital stay in critically ill patients if they received fish oil. Meta-analyses do not present a consistent picture but are limited by the small number and size of studies. More and better trials are needed in patient groups in which parenteral nutrition is used and where fish oil, as a source of bioactive omega-3 fatty acids, may offer benefits.

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Fractional exhaled nitric oxide for the management of asthma in adults: a systematic review

European Respiratory Journal ◽

10.1183/13993003.01882-2015 ◽

2016 ◽

Vol 47 (3) ◽

pp. 751-768 ◽

Cited By ~ 48

Author(s):

Munira Essat ◽

Sue Harnan ◽

Tim Gomersall ◽

Paul Tappenden ◽

Ruth Wong ◽

...

Keyword(s):

Nitric Oxide ◽

Rate Ratio ◽

Clinical Effectiveness ◽

Exhaled Nitric Oxide ◽

Severe Exacerbation ◽

Inhaled Corticosteroid ◽

Class Effect ◽

Fractional Exhaled Nitric Oxide ◽

Study Characteristics ◽

Meta Analyses

The aim of this review was to evaluate the clinical effectiveness of fractional exhaled nitric oxide (FeNO) measured in a clinical setting for the management of asthma in adults.13 electronic databases were searched and studies were selected against predefined inclusion criteria. Quality assessment was conducted using QUADAS-2. Class effect meta-analyses were performed.Six studies were included. Despite high levels of heterogeneity in multiple study characteristics, exploratory class effect meta-analyses were conducted. Four studies reported a wider definition of exacerbation rates (major or severe exacerbation) with a pooled rate ratio of 0.80 (95% CI 0.63–1.02). Two studies reported rates of severe exacerbations (requiring oral corticosteroid use) with a pooled rate ratio of 0.89 (95% CI 0.43–1.72). Inhaled corticosteroid use was reported by four studies, with a pooled standardised mean difference of −0.24 (95% CI −0.56–0.07). No statistically significant differences for health-related quality of life or asthma control were found.FeNOguided management showed no statistically significant benefit in terms of severe exacerbations or inhaled corticosteroid use, but showed a statistically significant reduction in exacerbations of any severity. However, further research is warranted to clearly define which management protocols (including cut-off points) offer best efficacy and which patient groups would benefit the most.

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Physiological responses to arm versus leg activity in patients with chronic obstructive pulmonary disease: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2017-019942 ◽

2018 ◽

Vol 8 (2) ◽

pp. e019942 ◽

Cited By ~ 3

Author(s):

Erik Frykholm ◽

Vanessa Pereira Lima ◽

Tania Janaudis-Ferreira ◽

Andre Nyberg

Keyword(s):

Systematic Review ◽

Chronic Obstructive Pulmonary Disease ◽

Pulmonary Disease ◽

Physiological Responses ◽

Population Exposure ◽

Chronic Obstructive ◽

Cochrane Central Register ◽

Obstructive Pulmonary Disease ◽

Study Characteristics ◽

Meta Analyses

IntroductionCompared with healthy older adults, people with chronic obstructive pulmonary disease (COPD) have reduced capacity and increased symptoms during leg and arm activities. While the mechanisms underlying limitations and symptoms during leg activities have been investigated in detail, limitations and symptoms during arm activities are not well understood, and the potential differences between physiological responses of leg and arm activities have not been systematically synthesised. Determining physiological responses and symptoms of arm activities compared with physiological responses and symptoms of leg activities will help us understand the mechanisms behind the difficulties that people with COPD experience when performing physical activities, and determine how exercise training should be prescribed. Thus, the aim of this systematic review is to compare the physiological responses and symptoms during activities involving the arms relative to activities involving the legs in people diagnosed with COPD.Methods and analysesThis protocol is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols. Potentially relevant studies will be identified from CINAHL, EMBASE, PEDro, Cochrane Central Register of Controlled Trials and PubMed databases. The Population, Exposure, Comparator, Outcomes, and Study characteristics framework will be used to systematise the process of selecting and extracting data from relevant studies. Assessment of the methodological quality of the studies will be done by using the 14 most relevant components from the checklist by Downs and Black. The result will be presented with a narrative synthesis, and if appropriate with meta-analyses.Ethics and disseminationEthical approval is not required as this study is a systematic review. It is our intention to submit the results of our review for peer-reviewed publication.PROSPERO registration numberCRD42017074476.

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