title: Factors associated with the onset and progression of neurotrauma: A systematic review of systematic reviews and meta-analyses.
abstract: Neurotrauma, including traumatic brain injury (TBI) and spinal cord injury (SCI), is a preventable condition that imposes an important burden on the Canadian society. In this study, the current evidence on risk factors for the onset and progression of neurotrauma is systematically reviewed and synthesized. Searches of the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), Medline and Medline in Process (via OVID), EMBASE and PsycINFO from inception to February 2013 were conducted to identify relevant systematic reviews and meta-analyses published in English or French. Two referees screened and assessed the quality of the studies using the AMSTAR tool. Thirty-two studies examined at least one risk factor for the onset of neurotrauma. Thirteen studies passed the quality assessment and the majority evaluated the impact of protective equipment in sports. Helmets effectively reduce TBI from bicycling, skiing, snowboarding, ice hockey and motorcycling. There was no evidence of a protective effect of helmets for SCI. No studies contributed evidence on risk factors for the onset of SCI. Of two studies examining risk factors for the progression of neurotrauma, only injury severity was found to be associated with poorer post-injury outcomes. Substantial evidence supports the use of helmets for the prevention of TBI in sports and motorcycling and face shields in ice hockey. Addressing bicycle helmet legislation across Canada may be an effective option for reducing TBI caused by bicycle accidents. Limited evidence on relevant risk factors for spinal cord injuries and neurotrauma progression was available.
authors.affiliation: School of Pharmacy, Memorial University of Newfoundland, Health Science Centre, St. John's, NL, Canada. Electronic address: jennifer.donnan@mun.ca.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Donnan
authors.affiliation: Newfoundland and Labrador Centre for Health Information, St. John's, NL, Canada.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Walsh
authors.affiliation: McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Yannick
authors.initials: Y
authors.lastname: Fortin
authors.affiliation: McLaughlin Centre for Population Health Risk Assessment, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Janet
authors.initials: J
authors.lastname: Gaskin
authors.affiliation: Health Sciences Library, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Sikora
authors.affiliation: School of Pharmacy, Memorial University of Newfoundland, Health Science Centre, St. John's, NL, Canada.
authors.forename: Andrea
authors.initials: A
authors.lastname: Morrissey
authors.affiliation: School of Pharmacy, Memorial University of Newfoundland, Health Science Centre, St. John's, NL, Canada.
authors.forename: Kayla
authors.initials: K
authors.lastname: Collins
authors.affiliation: School of Pharmacy, Memorial University of Newfoundland, Health Science Centre, St. John's, NL, Canada.
authors.forename: Don
authors.initials: D
authors.lastname: MacDonald
mesh_terms: D017668:Age of Onset; D000070642:Brain Injuries, Traumatic / Q000453:epidemiology* / Q000209:etiology*; D002170:Canada; D018450:Disease Progression; D006801:Humans; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000453:epidemiology* / Q000209:etiology*
keywords: Aetiology; Concussion; Post-concussion syndrome; Traumatic brain injury; Traumatic spinal cord injury