Abstract
Dear Editor:
Concussion describes an acute neurophysiological event related to a mechanical energy applied to the head, neck, or body with transmitting forces to the brain, such as from sudden acceleration, deceleration, or rotational forces. 1 Concussion has a major health and economic burden. It has an annual incidence of 1.2% at the population level and can result in somatic symptoms, mood changes, cognitive problems, school and work difficulties, and changes in social engagement, and can reduce the quality of a person's life for years post-injury. 2
The evidence informing assessment, diagnosis, and treatment of concussion is evolving at a rapid rate, 3 the certainty of a large proportion of the existing evidence is low, 1,4 and there is a need for unbiased systematic or scoping reviews to inform clinical practice and clinical practice guidelines. Traditionally, reviews (and guidelines based on reviews) become outdated due to new research being published and updates are often inefficient due to the interval of time between updates and the need for a new team to be assembled, resulting in potential loss of “institutional memory.” 5 For fields such as concussion, living reviews may be an effective solution. A living review is defined as a “review that is continually updated, incorporating relevant new evidence as it becomes available.” 5 These reviews are beneficial because they maintain their infrastructure, push the limits of literature currency and accuracy, and provide a set frequency of review (e.g., every 3-6 months), giving predictability to end users.
A living review is the key activity to inform living clinical practice guidelines. Living clinical practice guidelines allow for updating of individual clinical recommendations as soon as new evidence becomes available. 5 The main purpose of this letter is to inform the journal's readership of two ongoing living clinical practice guideline projects addressing concussion diagnosis and management in the pediatric and adult populations, respectively. These recent developments will be of interest to both clinicians/practitioners and patients aiming to manage concussion both in the acute and prolonged settings.
The pediatric guideline (“Living Guideline for Diagnosing and Managing Pediatric Concussion”) has been operational since 2019, whereas the adult guideline is currently being transitioned from its predecessor (“Guideline for Concussion/Mild Traumatic Brain Injury and Prolonged Symptoms, 3rd Edition for Adults Over 18 Years of Age”) published in 2018. 1,4 These living guidelines connect 50+ concussion experts from across North America who volunteer every 3-6 months to evaluate new evidence and consider changes to the guidelines.
The pediatric living guideline model has already begun to demonstrate its utility with the ability to timely integrate recent important recommendations for sub-symptom threshold aerobic exercise and recommendations for the use of telemedicine. Due to the high rate of evolving evidence, both guidelines will continuously undergo updates in the coming years. These projects are also supported by knowledge translation and implementation activities to ensure that the most current evidence is used by clinicians and patients in order to improve outcomes.