Randomized treatment trial in mild traumatic brain injury.
OBJECTIVE
To determine whether multidisciplinary treatment of mild traumatic brain injury (MTBI) improves neurobehavioral outcome at 6 months postinjury.


METHODS
Subjects with MTBI were randomly assigned to treatment (n=97) or nontreatment (control, n=94) groups. Treated patients were assessed within 1 week of injury and thereafter managed by a multidisciplinary team according to clinical need for a further 6 months. Control subjects were not offered treatment. Six-month outcome measures included: severity of postconcussive symptoms (Rivermead Post-Concussion Disorder Questionnaire), psychosocial functioning (Rivermead Follow-up Questionnaire), psychological distress (General Health Questionnaire), and cognition (neurocognitive battery).


RESULTS
Treatment and control subjects were well-matched for demographic and MTBI severity data. In addition, the two groups did not differ on any outcome measure. However, in individuals with preinjury psychiatric difficulties (22.9% of the entire sample), subjects in the treatment group had significantly fewer depressive symptoms 6 months postinjury compared with untreated controls (P=.01).


CONCLUSIONS
These findings suggest that routine treatment of all MTBI patients offers little benefit; rather, targeting individuals with preinjury psychiatric problems may prove a more rational and cost-effective approach.
Ghaffar
Omar
O
Department of Psychiatry, Sunnybrook and Women's College Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada M4N 3M5.
McCullagh
Scott
S
Ouchterlony
Donna
D
Feinstein
Anthony
A
D000328:Adult; D001930:Brain Injuries / Q000523:psychology* / Q000628:therapy*; D003071:Cognition; D005260:Female; D006801:Humans; D008297:Male; D008487:Medical History Taking; D010817:Physician-Patient Relations; D011613:Psychotherapy