Recommendation ID
CG176/5
Question
Predictors of long-term sequelae following head injury:- Research is needed to summarise and identify the optimal predictor variables for long-term sequelae following mild traumatic brain injury (TBI). A systematic review of the literature could be used to derive a clinical decision rule to identify relevant patients at the time of injury. This would in turn lay the foundation for a derivation cohort study.
Any explanatory notes
(if applicable)
Why this is important:- Although this recommendation was first made in 2007, the GDG felt that this is still an area of high priority for research and the question remains unanswered. The diagnosis of TBI is essentially a clinical one. However, although this approach provides the best current solution it can be imprecise, particularly in mild TBI where conventional imaging may be normal and cognitive abnormalities may be due to confounders such as pre-existing dementia, hypoxia or hypotension from associated injuries, alcohol or recreational drugs, and/or other conditions (such as post-traumatic stress disorder) which result in overlapping phenotypes (and possibly even imaging findings).
The availability of novel, objective methods of detecting brain injury provides an attractive means of better defining the presence of TBI in these contexts, with improvements in epidemiological precision. Perhaps more importantly, there is an increasing recognition that even mild TBI can result in prolonged cognitive and behavioural deficits, and the ability to identify patients at risk of these sequelae would aid clinical management, help determine which patients need novel therapeutic interventions, and refine resource allocation.
The techniques that have been explored in this regard include advanced neuroimaging with MRI, electroencephalographic (EEG) based diagnosis, and circulating biomarkers. The relative effectiveness and cost effectiveness of these techniques, individually and in combination, is not yet completely defined, and their role in contributing to a clinical decision rule that allows triage of patients to specific management pathways needs definition. A systematic review would be the first step in collating the available evidence in this area, followed by a rational application of available evidence, identification of key research questions that need to be addressed, and definition of the data collection needed in a derivation cohort study that allows these questions to be addressed.

Source guidance details

Comes from guidance
Head injury: assessment and early management
Number
CG176
Date issued
January 2014

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 28/02/2014