Early Treatment Interventions to Improve Outcome Following Mild Traumatic Brain Injury in Adults Presenting to the Emergency Department: A Systematic Review

Objective Most patients with mild traumatic brain injury (mTBI) presenting to the emergency department (ED) do not receive standardized follow‐up care or therapy, whereas early interventions may yield beneficial effect on posttraumatic symptoms. The objective of this systematic review was to assess the effect of early interventions, compared with usual care or placebo, on posttraumatic symptoms in patients (≥ 16 years) with mTBI presented at the ED. Methods PubMed, Embase, and Cochrane Library, were searched for articles concerning early interventions (started within three months post‐injury) after mTBI. Randomized controlled trials (RCTs) and clinical controlled trials were selected. Outcome could be measured in various ways, such as presence of posttraumatic symptoms, functional outcome, and/or quality of life. The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Two reviewers independently selected studies for inclusion and subsequently extracted the necessary data. The methodological quality of the included studies was assessed using the Risk of Bias Tool 2 for RCTs and Newcastle–Ottawa Scale for clinical controlled trials. Mainly due to heterogeneity of outcome measures, conducting a meta‐analysis was not possible. Results From 3202 citations, 111 were potentially relevant and 19 were included involving 3357 participants with mTBI (three studies on physical therapy/exercise, 11 on psychoeducation and five on multidisciplinary interventions). We found no evidence for the improvement of posttraumatic symptoms following physical therapy/exercise or multidisciplinary therapy compared with usual care. A better outcome was demonstrated in four psychoeducation studies, with two providing multiple sessions. Nevertheless, the limited number studies, the small sample sizes, the discrepancies in study design and our concerns about the quality of studies make it difficult to draw solid conclusions. Conclusions Current evidence on the efficacy of early interventions for patients with mTBI presenting at the ED is limited. Based on the available literature, no clear advice can be provided on which early interventions are effective to prevent posttraumatic symptoms and unfavorable functional outcome in patients with mTBI. Repeated psychoeducation appears to have some potential benefit. We advocate future research focusing on patients at high risk of long‐term posttraumatic symptoms in combination with symptom‐guided therapies to improve posttraumatic complaints and functional outcome in mTBI. PROSPERO database (registration number 2024 CRD42024511509).