Fifteen RCTs met the inclusion criteria (7,275 participants, range 17 to 2,602). Five trials were considered to be at a high risk of bias, and six an unclear risk of bias. Randomisation generation and allocation concealment were the main areas of limitation.
Different follow-up interventions (seven trials): Compared with routine or no follow-up, a follow-up intervention had a positive effect in three studies using a telephone call and information booklets, with (two trials) or without (one trial) follow-up in a specialized clinic five to seven days after the trauma. Meta-analyses of four trials showed no significant benefit of a follow-up intervention for headache, concentration, memory, dizziness, vision, fatigue, irritability, anxiety, depression, or sensitivity to noise. Results of subgroup analyses were reported.
Information interventions (four trials): Three trials reported no benefit compared to usual care in decreasing post-concussion symptoms, while one trial reported that meeting with a specialized therapist and the provision of a 10-page information booklet decreased post-concussion symptoms. One trial suggested that standardized information and reassurance provided at the emergency department was associated with faster return to work and social activities. Overall, there was no association between the intervention and the persistence of headache (RR 0.88, 95% CI 0.65 to 1.19) or vision impairment (RR 0.58, 95% CI 0.10 to 3.31).
Compared with placebo (one trial with 17 adults), 10μg twice daily of nasal 1-desamino-8-d-arginine-vasopressin administered for five days was associated with better performance on two memory tests on the third day of treatment (data not provided); the intervention had no influence on four other cognitive outcomes.
Neither full bed rest (one trial) nor admission (one trial) showed a significant clinical benefit between two weeks to six months.
Immediate head computed tomography showed no significant difference at six months when compared to admission (one trial).