. 2023 Dec 9;13(12):e077022.

doi: 10.1136/bmjopen-2023-077022.

Specialist healthcare services for concussion/mild traumatic brain injury in England: a consensus statement using modified Delphi methodology

Elika Karvandi¹, Adel Helmy², Angelos G Kolias², Antonio Belli³, Mario Ganau⁴, Clint Gomes^{5

6}, Michael Grey⁷, Michael Griffiths^{8

9}, Timothy Griffiths^{10

11}, Philippa Griffiths¹², Damian Holliman¹³, Peter Jenkins^{14

15}, Ben Jones^{16

17}, Tim Lawrence⁴, Terence McLoughlin⁵, Catherine McMahon¹⁸, Shrouk Messahel¹⁹, Joanne Newton²⁰, Rupert Noad²¹, Vanessa Raymont²², Kanchan Sharma²³, Richard Sylvester^{24

25}, Daniel Tadmor^{26

27}, Peter Whitfield²¹, Mark Wilson^{15

28}, Emma Woodberry²⁹, Michael Parker³⁰, Peter John Hutchinson²

Affiliations

¹ Department of Neurosurgery, University of Cambridge, Cambridge, UK eek34@cam.ac.uk.
² Department of Neurosurgery, University of Cambridge, Cambridge, UK.
³ Inflammation and Ageing, University of Birmingham, Birmingham, UK.
⁴ Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
⁵ Royal Liverpool University Hospital, Liverpool, UK.
⁶ UK Sports Institute, Liverpool, UK.
⁷ School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
⁸ Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.
⁹ Department of Paediatric Neurology, Alder-Hey Children's NHS Trust, Liverpool, UK.
¹⁰ Department of Cognitive Neurology, Newcastle University, Newcastle Upon Tyne, UK.
¹¹ Institute of Neurology, University College London, London, UK.
¹² Sunderland & South Tyneside Community Acquired Brain Injury Service, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.
¹³ Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
¹⁴ Wessex Neuroscience Centre, Southampton General Hospital, Southampton, UK.
¹⁵ Imperial College London, London, UK.
¹⁶ Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University-Headingley Campus, Leeds, UK.
¹⁷ England Performance Unit, Rugby Football League Ltd, Leeds, UK.
¹⁸ Manchester Centre for Clinical Neurosciences (MCCN), Salford Royal Infirmary, Northern Care Alliance, Liverpool, UK.
¹⁹ Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK.
²⁰ Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
²¹ University Hospitals Plymouth NHS Trust, Plymouth, UK.
²² Department of Psychiatry, University of Oxford, Oxford, UK.
²³ Department of Neurology, North Bristol NHS Trust, Westbury on Trym, UK.
²⁴ National Hospital for Neurology and Neurosurgery, London, London, UK.
²⁵ Institute of Exercise and Health, University College London, London, UK.
²⁶ Carnegie School of Sport, Leeds Beckett University, Leeds, UK.
²⁷ Medical, Leeds Rhinos Rugby League Club, Leeds, UK.
²⁸ Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK.
²⁹ Department of Neuropsychology, University of Cambridge, Cambridge, UK.
³⁰ Love of the Game, London, UK.

PMID: 38070886
PMCID: PMC10729241
DOI: 10.1136/bmjopen-2023-077022

Specialist healthcare services for concussion/mild traumatic brain injury in England: a consensus statement using modified Delphi methodology

Elika Karvandi et al. BMJ Open. 2023.

. 2023 Dec 9;13(12):e077022.

doi: 10.1136/bmjopen-2023-077022.

Authors

Affiliations

¹ Department of Neurosurgery, University of Cambridge, Cambridge, UK eek34@cam.ac.uk.
² Department of Neurosurgery, University of Cambridge, Cambridge, UK.
³ Inflammation and Ageing, University of Birmingham, Birmingham, UK.
⁴ Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
⁵ Royal Liverpool University Hospital, Liverpool, UK.
⁶ UK Sports Institute, Liverpool, UK.
⁷ School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
⁸ Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK.
⁹ Department of Paediatric Neurology, Alder-Hey Children's NHS Trust, Liverpool, UK.
¹⁰ Department of Cognitive Neurology, Newcastle University, Newcastle Upon Tyne, UK.
¹¹ Institute of Neurology, University College London, London, UK.
¹² Sunderland & South Tyneside Community Acquired Brain Injury Service, Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.
¹³ Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
¹⁴ Wessex Neuroscience Centre, Southampton General Hospital, Southampton, UK.
¹⁵ Imperial College London, London, UK.
¹⁶ Carnegie Applied Rugby Research (CARR) Centre, Leeds Beckett University-Headingley Campus, Leeds, UK.
¹⁷ England Performance Unit, Rugby Football League Ltd, Leeds, UK.
¹⁸ Manchester Centre for Clinical Neurosciences (MCCN), Salford Royal Infirmary, Northern Care Alliance, Liverpool, UK.
¹⁹ Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK.
²⁰ Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK.
²¹ University Hospitals Plymouth NHS Trust, Plymouth, UK.
²² Department of Psychiatry, University of Oxford, Oxford, UK.
²³ Department of Neurology, North Bristol NHS Trust, Westbury on Trym, UK.
²⁴ National Hospital for Neurology and Neurosurgery, London, London, UK.
²⁵ Institute of Exercise and Health, University College London, London, UK.
²⁶ Carnegie School of Sport, Leeds Beckett University, Leeds, UK.
²⁷ Medical, Leeds Rhinos Rugby League Club, Leeds, UK.
²⁸ Department of Neurosurgery, Imperial College Healthcare NHS Trust, London, UK.
²⁹ Department of Neuropsychology, University of Cambridge, Cambridge, UK.
³⁰ Love of the Game, London, UK.

PMID: 38070886
PMCID: PMC10729241
DOI: 10.1136/bmjopen-2023-077022

Abstract

Objective: To establish a consensus on the structure and process of healthcare services for patients with concussion in England to facilitate better healthcare quality and patient outcome.

Design: This consensus study followed the modified Delphi methodology with five phases: participant identification, item development, two rounds of voting and a meeting to finalise the consensus statements. The predefined threshold for agreement was set at ≥70%.

Setting: Specialist outpatient services.

Participants: Members of the UK Head Injury Network were invited to participate. The network consists of clinical specialists in head injury practising in emergency medicine, neurology, neuropsychology, neurosurgery, paediatric medicine, rehabilitation medicine and sports and exercise medicine in England.

Primary outcome measure: A consensus statement on the structure and process of specialist outpatient care for patients with concussion in England.

Results: 55 items were voted on in the first round. 29 items were removed following the first voting round and 3 items were removed following the second voting round. Items were modified where appropriate. A final 18 statements reached consensus covering 3 main topics in specialist healthcare services for concussion; care pathway to structured follow-up, prognosis and measures of recovery, and provision of outpatient clinics.

Conclusions: This work presents statements on how the healthcare services for patients with concussion in England could be redesigned to meet their health needs. Future work will seek to implement these into the clinical pathway.

Keywords: neurological injury; patient-centered care; public health.

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Conflict of interest statement

Competing interests: AB serves as an expert advisor on concussion for England’s Rugby Football Union, Football Association and Premier League. He also consults and has stocks in Marker Diagnostics LTD and licenses in Salivary Biomarker of Concussion. AH served on the NICE Guideline Committee Trauma Guidelines for 2023. BJ consults for Premiership Rugby, London, and Rugby Football League, Manchester. DT consults for the Leeds Rhinos Rugby League Club and Hull City Tigers Football Club. MG serves on the advisory board for the Players Football Association. RN has undertaken work as a medicolegal expert in sports concussions. RS has served as an independent expert in legal cases in which head injury has occurred, some of these were mild head injuries. He also has received funding from the Rugby Football Association and Football Association for the Advanced Brainhealth project. TG has advised on legal cases where head injury has occurred, some of which were mild head injuries.

Figures

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References

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1. Sharp DJ, Jenkins PO. Concussion is confusing us all. Pract Neurol 2015;15:172–86. 10.1136/practneurol-2015-001087 Available: https://www.scopus.com/inward/record.uri?eid=2-s2.0-84929330344&doi=10.1... - DOI - PMC - PubMed
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Specialist healthcare services for concussion/mild traumatic brain injury in England: a consensus statement using modified Delphi methodology

Affiliations

Specialist healthcare services for concussion/mild traumatic brain injury in England: a consensus statement using modified Delphi methodology

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical