Service Delivery Models for the Management of Pediatric and Adolescent Concussion: A Systematic Review

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Objective

To examine the current peer-reviewed literature on pediatric concussion and mild traumatic brain injury (mTBI) service delivery models (SDMs) and relevant cost analyses.

Data Sources

PubMed, Embase (Elsevier), CINAHL Plus (EBSCO), APA PsycINFO (EBSCO), and Web of Science Core Collection, limited to human trials published in English from January 1, 2001, to January 10, 2022.

Study Selection

Included articles that (1) were peer-reviewed; (2) were evidence-based; (3) described service delivery and/or associated health care costs; and (4) focused on mTBI, concussion, or postconcussion symptoms of children and adolescents. Studies describing emergency department–based interventions, adults, and moderate to severe brain injuries were excluded.

Data Extraction

The initial search resulted in 1668 articles. Using Rayyan software, 2 reviewers independently completed title and abstract screening followed by a full-text screening of potentially included articles. A third blinded reviewer resolved inclusion/exclusion conflicts among the other reviewers. This resulted in 28 articles included.

Data Synthesis

Each of the 28 articles were grouped into 1 of the following 3 categories: generalist-based services (7), specialist-based services (12), and web/telemedicine services (6). One article discussed both generalists and specialists. It was clear that specialists are more proactive in their treatment of concussion than generalists. Most of the research on generalists emphasized the need for education and training. Four studies discussed costs relevant to SDMs.

Conclusions

This review highlights the need for more discussion and formalized evaluation of SDMs to better understand concussion management. Overall there is more literature on specialist-based services than generalist-based services. Specialists and generalists have overarching similarities but differ often in their approach to pediatric concussion management. Cost analysis data are sparse and more research is needed.

Related collections

Most cited references 50

Record: found
Abstract: found
Article: found

Is Open Access

Rayyan—a web and mobile app for systematic reviews

Mourad Ouzzani, Hossam Hammady, Zbys Fedorowicz … (2017)

Background Synthesis of multiple randomized controlled trials (RCTs) in a systematic review can summarize the effects of individual outcomes and provide numerical answers about the effectiveness of interventions. Filtering of searches is time consuming, and no single method fulfills the principal requirements of speed with accuracy. Automation of systematic reviews is driven by a necessity to expedite the availability of current best evidence for policy and clinical decision-making. We developed Rayyan (http://rayyan.qcri.org), a free web and mobile app, that helps expedite the initial screening of abstracts and titles using a process of semi-automation while incorporating a high level of usability. For the beta testing phase, we used two published Cochrane reviews in which included studies had been selected manually. Their searches, with 1030 records and 273 records, were uploaded to Rayyan. Different features of Rayyan were tested using these two reviews. We also conducted a survey of Rayyan’s users and collected feedback through a built-in feature. Results Pilot testing of Rayyan focused on usability, accuracy against manual methods, and the added value of the prediction feature. The “taster” review (273 records) allowed a quick overview of Rayyan for early comments on usability. The second review (1030 records) required several iterations to identify the previously identified 11 trials. The “suggestions” and “hints,” based on the “prediction model,” appeared as testing progressed beyond five included studies. Post rollout user experiences and a reflexive response by the developers enabled real-time modifications and improvements. The survey respondents reported 40% average time savings when using Rayyan compared to others tools, with 34% of the respondents reporting more than 50% time savings. In addition, around 75% of the respondents mentioned that screening and labeling studies as well as collaborating on reviews to be the two most important features of Rayyan. As of November 2016, Rayyan users exceed 2000 from over 60 countries conducting hundreds of reviews totaling more than 1.6M citations. Feedback from users, obtained mostly through the app web site and a recent survey, has highlighted the ease in exploration of searches, the time saved, and simplicity in sharing and comparing include-exclude decisions. The strongest features of the app, identified and reported in user feedback, were its ability to help in screening and collaboration as well as the time savings it affords to users. Conclusions Rayyan is responsive and intuitive in use with significant potential to lighten the load of reviewers.

0 comments Cited 4457 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: found

Is Open Access

Barriers and Facilitators That Influence Telemedicine-Based, Real-Time, Online Consultation at Patients’ Homes: Systematic Literature Review

Hassan Almathami, Khin Win, Elena Vlahu-Gjorgievska (2020)

Background Health care providers are adopting information and communication technologies (ICTs) to enhance their services. Telemedicine is one of the services that rely heavily on ICTs to enable remote patients to communicate with health care professionals; in this case, the patient communicates with the health care professional for a follow-up or for a consultation about his or her health condition. This communication process is referred to as an e-consultation. In this paper, telemedicine services refer to health care services that use ICTs, which enable patients to share, transfer, and communicate data or information in real time (ie, synchronous) from their home with a care provider—normally a physician—at a clinical site. However, the use of e-consultation services can be positively or negatively influenced by external or internal factors. External factors refer to the environment surrounding the system as well as the system itself, while internal factors refer to user behavior and motivation. Objective This review aims to investigate the barriers and the facilitators that influence the use of home consultation systems in the health care context. This review also aims to identify the effectiveness of Home Online Health Consultation (HOHC) systems in improving patients’ health as well as their satisfaction with the systems. Methods We conducted a systematic literature review to search for articles—empirical studies—about online health consultation in four digital libraries: Scopus, Association for Computing Machinery, PubMed, and Web of Science. The database search yielded 2518 articles; after applying the inclusion and exclusion criteria, the number of included articles for the final review was 45. A qualitative content analysis was performed to identify barriers and facilitators to HOHC systems, their effectiveness, and patients’ satisfaction with them. Results The systematic literature review identified several external and internal facilitators and barriers to HOHC systems that were used in the creation of a HOHC framework. The framework consists of four requirements; the framework also consists of 17 facilitators and eight barriers, which were further categorized as internal and external influencers on HOHC. Conclusions Patients from different age groups and with different health conditions benefited from remote health services. HOHC via video conferencing was effective in delivering online treatment and was well-accepted by patients, as it simulated in-person, face-to-face consultation. Acceptance by patients increased as a result of online consultation facilitators that promoted effective and convenient remote treatment. However, some patients preferred face-to-face consultation and showed resistance to online consultation. Resistance to online consultation was influenced by some of the identified barriers. Overall, the framework identified the facilitators and barriers that positively and negatively influenced the uptake of HOHC systems, respectively.

0 comments Cited 238 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Epidemiology of postconcussion syndrome in pediatric mild traumatic brain injury.

K M Barlow, S. Crawford, A. Stevenson … (2010)

Much disagreement exists as to whether postconcussion syndrome (PCS) is attributable to brain injury or to other factors such as trauma alone, preexisting psychosocial problems, or medicolegal issues. We investigated the epidemiology and natural history of PCS symptoms in a large cohort of children with a mild traumatic brain injury (mTBI) and compared them with children with an extracranial injury (ECI). This investigation was a prospective, consecutive controlled-cohort study of 670 children who presented to a tertiary referral emergency department with mTBI and 197 children who presented with ECI. For all participants, data were collected by use of a telephone interview of a parent 7 to 10 days after injury. If a change from preinjury symptoms was reported by a parent, follow-up continued monthly until symptom resolution. Outcomes were measured by using the Post Concussion Symptom Inventory, Rivermead Postconcussion Symptom Questionnaire, Brief Symptom Inventory, and Family Assessment Device. There was a significant difference between the mTBI and ECI groups in their survival curves for time to symptom resolution (log rank [Mantel-Cox] 11.15, P < .001). Three months after injury, 11% of the children in the mTBI group were symptomatic (13.7% of children older than 6 years) compared with 0.5% of the children in the ECI group. The prevalence of persistent symptoms at 1 year was 2.3% in the mTBI group and 0.01% in the ECI group. Family functioning and maternal adjustment did not differ between groups. Among school-aged children with mTBI, 13.7% were symptomatic 3 months after injury. This finding could not be explained by trauma, family dysfunction, or maternal psychological adjustment. The results of this study provide clear support for the validity of the diagnosis of PCS in children.

0 comments Cited 134 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Barry S. Willer

Journal

Journal ID (nlm-ta): Arch Rehabil Res Clin Transl

Journal ID (iso-abbrev): Arch Rehabil Res Clin Transl

Title: Archives of Rehabilitation Research and Clinical Translation

Publisher: Elsevier

ISSN (Electronic): 2590-1095

Publication date PMC-release: 30 July 2022

Publication date Collection: December 2022

Publication date (Electronic): 30 July 2022

Volume: 4

Issue: 4

Electronic Location Identifier: 100221

Affiliations

[a ]Division of Physical Medicine and Rehabilitation, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada

[b ]GF Strong Rehabilitation Centre, Vancouver, British Columbia, Canada

[c ]UBMD Orthopedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY

[d ]Department of Rehabilitation Sciences, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY

[e ]University Libraries, University at Buffalo, Buffalo, NY

[f ]Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY

Author notes

[* ]Corresponding author Barry Willer, PhD, 160 Farber Hall, 3435 Main St, Buffalo, NY, 14214. bswiller@ 123456buffalo.edu

Article

Publisher Item ID: S2590-1095(22)00049-0 Publisher ID: 100221

DOI: 10.1016/j.arrct.2022.100221

PMC ID: 9761252

PubMed ID: 36545517

SO-VID: 651c021d-721d-4446-9815-fdf4460e47ba

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Service Delivery Models for the Management of Pediatric and Adolescent Concussion: A Systematic Review

Read this article at

Abstract

Objective

Data Sources

Study Selection

Data Extraction

Data Synthesis

Conclusions

Related collections

RNA drug delivery

Most cited references 50

Rayyan—a web and mobile app for systematic reviews

Barriers and Facilitators That Influence Telemedicine-Based, Real-Time, Online Consultation at Patients’ Homes: Systematic Literature Review

Epidemiology of postconcussion syndrome in pediatric mild traumatic brain injury.

Author and article information

Contributors

Journal

Affiliations

Author notes

Article

History

Categories

Comments

Comment on this article

Similar content 383

Cited by 1

Most referenced authors 556