Intracranial pressure changes after mild traumatic brain injury: a systematic review.
Mohammad Nadir Haider, John J Leddy, Andrea L Hinds and 4 others
PMID 29701515WHAT IT FOUND
Evidence that mild traumatic brain injury raises intracranial pressure is limited and mixed.
Four of five animal studies suggested pressure increases, but two of four human studies did not. Do not assume raised pressure causes concussion symptoms.
Key findings
01Two of four human studies suggested increased intracranial pressure after mild traumatic brain injury, and two did not.
02Four of five animal studies suggested increased intracranial pressure, and one did not.
03The review could not combine the studies because study designs, species, injury mechanisms, timing, and pressure measurement methods were heterogeneous.
STILL TO COME
How it was doneWhat they found
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What it does not show
The review included only nine articles, and it could not combine them because study designs, species, injury mechanisms, timing, and pressure measurement methods were very different. Most supporting studies were animal work, so the pressure findings may not transfer to people. Human studies were few and mixed, and pressure was often measured indirectly. Indirect methods give estimated rather than direct values. One interesting human finding was from an abstract or poster with no published original article. The included studies were low to moderate quality, with little adjustment for confounding and poor reporting of compliance and follow-up in human studies. The review searched only English full texts, and reviewer agreement after title and abstract screening was 0.61. Only one included study was published more than 10 years ago, and older definitions of mild injury differed from current definitions.
Declared interests
The supplied text does not report a funding or conflict-of-interest declaration; the publication types list Research Support, N.I.H., Extramural.
The easy way to misread this
Do not treat mild traumatic brain injury as confirmed intracranial hypertension or use hypertonic saline based on this review. The review included nine studies, only four human studies, and the human results were mixed; most supporting studies were animal work.