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.

Interesting. I'll have to check it out more when I'm having a better day.

My mind is mush today.

Broken Brain is also posting analyses while reading:

http://brokenbrilliant.wordpress.com/

So far, none of the brokenbrilliance blogs have reviewed into the core of the Guidelines. I look forward to the March 17 review that starts <I’m back to reading the>. The reviewer appears to be very thorough.

Interesting, the above reviewer has be good at describing the focus of determining if it is possible to differentiate between those who spontaneously recover vs the 15% or so who have prolonged symptoms. He/She also notes how the goal is to identify any treatments that can be done from the beginning of the injury and diagnosis to slow or lessen the level of deterioration.

They don't appear to not have found the research about the use of progesterone to reduce the long term damage. Maybe the author of the progesterone research would not release the research data due to his attempt to protect his patent efforts.

Some reports claim that Acetyl-L-Carnitine also has a benefit at reducing long term damage. This is also not mentioned.

There is little reference to the treatments suggested for early intervention of long term damage.

Was this a report in preparation of a grant request for further research?

I really don't know... and I'm not sure how to find out.

The Ontario Neurotrauma Foundation website is strangely unnavigable and uninformative. Other than the PDF, I was unable to glean much of anything useful from it. That's why I posted the link to the concussion blog instead.

At least there is a document that one can give to PCPs that indicates we are not "making it all up." Certainly more clinical research is needed on some of the medications and supplements (and when is clinical research EVER adequately done on natural remedies :rolleyes:) but at least it is a start.

I would be interested to see some dialogue between you and BrokenBrilliant on the blog, too, Mark!