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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

Carol Cancelliere1*, J David Cassidy1234, Pierre Côté13, Cesar A Hincapié13, Jan Hartvigsen25, Linda J Carroll67, Connie Marras89, Eleanor Boyle1103, Vicki Kristman11123, Ryan Hung1314, Britt-Marie Stålnacke15, Peter Rumney1314, Victor Coronado16, Lena W Holm17, Jörgen Borg18, Catharina Nygren-de Boussard18, Jean-Luc af Geijerstam19 and Michelle Keightley20

Author Affiliations

1 Division of Health Care and Outcomes Research, Toronto Western Research Institute, University Health Network, Ontario, Canada

2 Institute of Sport Science and Clinical Biomechanics, Faculty of Health, University of Southern Denmark, Odense, Denmark

3 Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada

4 Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada

5 Nordic Institute of Chiropractic and Clinical Biomechanics, Odense, Denmark

6 Department of Epidemiology, School of Public Health, University of Alberta, Alberta, Canada

7 Alberta Centre for Injury Control and Research, Alberta, Canada

8 Department of Neurology, University of Toronto, Ontario, Canada

9 Movement Disorders Clinic, Toronto Western Hospital, Ontario, Canada

10 Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada

11 Department of Health Sciences, Lakehead University, Ontario, Canada

12 Institute for Work and Health, Toronto, Ontario, Canada

13 Department of Rehabilitation and Complex Continuing Care, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada

14 Department of Pediatrics, University of Toronto, Ontario, Canada

15 Department of Community Medicine and Rehabilitation, Umeå University, Sweden

16 National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, USA

17 Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden

18 Department of Rehabilitation Medicine, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden

19 Department of Medicine, Unit of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden

20 Department of Occupational Science and Occupational Therapy, University of Toronto, Ontario, Canada

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Systematic Reviews 2012, 1:17  doi:10.1186/2046-4053-1-17

Published: 23 February 2012



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.


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.


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.