Systematic Review of Self-Reported Prognosis in Adults After Mild Traumatic Brain Injury

To update the MTBI prognosis review published by the WHO Task Force in 2004. Systematic review and best-evidence synthesis. MEDLINE, PsycINFO, Embase, CINAHL and SPORTDiscus were searched from 2001 to 2012. We included published, peer-reviewed studies. Controlled trials, cohort and case-control studies were selected according to predefined criteria. Studies were included with more than 30 adult MTBI cases. Not applicable. Self-reported outcomes in adults. Evidence from accepted studies was synthesized qualitatively into key findings, and prognostic information was prioritized according to design as exploratory or confirmatory. Of 299 reviewed studies, 101 (34%) were accepted and form our evidence base of prognostic studies. Of these, 23 addressed self-reported outcomes in adults, including two of the three original ICoMP research studies. These studies show that common post-concussion symptoms are not specific to MTBI/concussion and occur after other injuries as well. Poor recovery after MTBI is associated with poorer pre-morbid mental and physical health status and with more injury-related stress. Most recover over one year, but persistent symptoms are more likely in those with more acute symptoms and more emotional stress. Common subjective symptoms after MTBI are not necessarily caused by brain injury per se, but they can be persistent in some patients. Those with more initial complaints and psychological distress recover slower. We need more high-quality research on these issues.