The Ontario Neurotrauma Foundation (ONF) initiated this project in 2008 with the overall objective to create a guideline that can be used by healthcare professionals to implement evidence-based, best-practice care of individuals who incur a concussion and experience prolonged symptoms. The first edition of the Clinical Practice Guidelines for Mild Traumatic Brain Injury and Persistent Symptoms was published online on the guidelines website in 2010, and in Canadian Family Physician1 in 2012. This guideline was informed by a search of existing clinical practice guidelines and a systematic review of the literature evaluating treatment of post-concussion symptoms between 1998-2008. The first expert consensus meeting to review the evidence and develop the guideline took place November 24th-25th, 2008, in Toronto. Prior to the first edition, the best practice for treatment of those with prolonged symptoms was not clearly defined. Therefore, the guidelines aimed to identify whether patients at risk of prolonged symptoms could be screened for acutely, and if a management plan could be developed to treat common prolonged symptoms associated with concussion.
The second edition aimed to update the guidelines based on literature published between 2008-2012 to maintain relevancy and utility, to modify the format to ensure accessibility for various stakeholders and healthcare workers, and to expand the expert consensus group for greater representation of healthcare professions serving concussion by broadening the represented domains of expertise and the geographical locations. This version was also meant to be more interactive and searchable to enhance implementability. The second edition was posted online in 2013 and published in Brain Injury2 in 2015.
The third edition of the of the Guidelines for Concussion/Mild Traumatic Brain Injury and Persistent Symptoms was the first fully functional website version of the guidelines. This edition aimed to update the recommendations based on the current evidence published between 2012-2017, to modify the guidelines based on feedback from stakeholders and frontline users, and to work alongside stakeholders and healthcare providers to generate further ideas for knowledge translation. Patient guidelines in both French and English were also developed.
To ensure the guideline is informed by the current best available evidence, particularly in a field where the literature is ever evolving, the newest version is now a living guideline. Living guidelines are updated as evidence becomes available. The Living Concussion Guidelines: Guideline for Concussion & Prolonged Symptoms for Adults 18 Years of Age or Older is informed by an ongoing systematic review taking place at minimum every 6 months, virtual expert panel meetings, and expert consensus through online surveys. Since the ONF has dissolved, the responsibility for this guideline has been transferred to the Ontario Ministry of Health. The protocol for this systematic review was published in BMJ Open3.
The development of these guidelines would not have been possible without the help of many dedicated people. Please use the following links to view the team members from the previous editions and the current edition:
1. Marshall S, Bayley M, McCullagh S, Velikonja D, Berrigan L. Clinical practice guidelines for mild traumatic brain injury and persistent symptoms. Can Fam Physician. 2012;58(3):257-e140.
2. Marshall S, Bayley M, McCullagh S, et al. Updated clinical practice guidelines for concussion/mild traumatic brain injury and persistent symptoms. Brain Inj. 2015;29(6):688-700. doi:10.3109/02699052.2015.1004755
3. Lithopoulos A, Bayley M, Curran D, et al. Protocol for a living systematic review for the management of concussion in adults. BMJ Open. 2022;12(7):e061282.