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Old 03-17-2012, 06:01 PM
Mark in Idaho Mark in Idaho is offline
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15 yr Member
Mark in Idaho Mark in Idaho is offline
Legendary
 
Join Date: Feb 2009
Location: Somewhere near here
Posts: 11,418
15 yr Member
Default Ontario Neurotrauma Foundation guidelines for concussion

A link to these guidelines is in the 'links' sticky above.

The full 156 pages of the pdf are a very interesting and exhausting read. It took me two naps between reading segments to completely read it.

Although at face value, it is very thorough, it if fraught with problems.

The most basic problems are these:

It relies almost entirely on a review of work published based on the research of others. Much of this research is inappropriately overly narrow in focus resulting in results that are easily taken out of context of the bigger picture.

The attempt to combine this data results in a hodgepodge of information with too many variables left for the practitioner. i.e. There is a frequent suggestion of somatoform and psychogenic causations included with the physiological causations. This can result in a misdirected diagnosis of causation of symptoms by the practitioner who has previously held biases.

It relies heavily on PCP's who have immersed themselves in the information presented. The information presented is extremely difficult to digest. It is unlikely that many PCP's will expend the time necessary to properly understand the information and guidelines. The guidelines also presuppose an understanding of the range of values used in assessing symptoms.

Many of the research based articles used are sorely lacking due to narrow focus causing information to be easily misinterpreted. It is an extension of the old axiom: There are three kinds of mistruths, Lies, damn lies and statistics. It is likely than many of the research articles are the result of Ph.D students' need to complete a thesis that does not overlap prior work.

The analysis is completely lacking of any inclusion of prior concussion/mTBI history while including many other pre-existing conditions that can cloud the diagnosis.

On the strong side, there are a number of valuable compilations of information.

The drug matrix is extensive in its inclusion of many different classes of drugs that the patient may be taking. Its only weakness is it only lists drugs with a know adverse effect on greater than 5% of patients. Those drugs that exhibit no increase in symptoms or an increase in symptoms in less than 5% of patients are left out entirely. It allows a comparison of various drugs.

It can be found on pages 94 and 95 of the pdf. at http://onf.org/documents/Guidelines%...20Symptoms.pdf
It can be assumed that drugs not listed fall into the 'below 5% category' but then this is just an 'assumption.' Most of us know what happens when we 'assume.'

If others find section of importance, feel free to add them to this thread. There are many other valuable tidbits in the 156 pages.

Now, back to my nap.
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Mark in Idaho

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