Department of Psychology, University of British Columbia, Vancouver, Canada; Vancouver Coastal Health Research Institute, Vancouver, Canada; Djavad Mowafaghian Centre for Brain Health, Vancouver, Canada.
Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Sports Concussion Program, MassGeneral Hospital for Children, Boston, MA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA; Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA; Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA.
Arch Phys Med Rehabil. 2023 Aug;104(8):1343-1355. doi: 10.1016/j.apmr.2023.03.036. Epub 2023 May 19.
To develop new diagnostic criteria for mild traumatic brain injury (TBI) that are appropriate for use across the lifespan and in sports, civilian trauma, and military settings.
Rapid evidence reviews on 12 clinical questions and Delphi method for expert consensus.
The Mild Traumatic Brain Injury Task Force of the American Congress of Rehabilitation Medicine Brain Injury Special Interest Group convened a Working Group of 17 members and an external interdisciplinary expert panel of 32 clinician-scientists. Public stakeholder feedback was analyzed from 68 individuals and 23 organizations.
The first 2 Delphi votes asked the expert panel to rate their agreement with both the diagnostic criteria for mild TBI and the supporting evidence statements. In the first round, 10 of 12 evidence statements reached consensus agreement. Revised evidence statements underwent a second round of expert panel voting, where consensus was achieved for all. For the diagnostic criteria, the final agreement rate, after the third vote, was 90.7%. Public stakeholder feedback was incorporated into the diagnostic criteria revision prior to the third expert panel vote. A terminology question was added to the third round of Delphi voting, where 30 of 32 (93.8%) expert panel members agreed that 'the diagnostic label 'concussion' may be used interchangeably with 'mild TBI' when neuroimaging is normal or not clinically indicated.'
New diagnostic criteria for mild TBI were developed through an evidence review and expert consensus process. Having unified diagnostic criteria for mild TBI can improve the quality and consistency of mild TBI research and clinical care.
制定新的轻度创伤性脑损伤（TBI）诊断标准，适用于整个生命周期以及运动、民用创伤和军事环境。
对 12 个临床问题进行快速证据审查和德尔菲法专家共识。
美国康复医学大会脑损伤特别兴趣小组的轻度创伤性脑损伤工作组召集了一个由 17 名成员组成的工作组和一个由 32 名临床医生-科学家组成的外部跨学科专家小组。公共利益相关者的反馈意见来自 68 个人和 23 个组织进行了分析。
前两轮德尔菲投票要求专家小组对轻度 TBI 的诊断标准及其支持证据陈述进行评分。在第一轮投票中，12 个证据陈述中有 10 个达成了共识。经过第二轮专家小组投票，对修订后的证据陈述达成了一致。对于诊断标准，在第三轮投票后，最终的一致率为 90.7%。在进行第三轮专家小组投票之前，将公众利益相关者的反馈纳入了诊断标准的修订。在第三轮德尔菲投票中增加了一个术语问题，32 名专家小组成员中的 30 名（93.8%）同意“当神经影像学正常或无临床指征时，诊断标签‘脑震荡’可与‘轻度 TBI’互换使用”。
通过证据审查和专家共识过程制定了新的轻度 TBI 诊断标准。统一轻度 TBI 的诊断标准可以提高轻度 TBI 研究和临床护理的质量和一致性。
