Formulation of Recommendations and Updating Procedure
To access the full published Living Concussion Guidelines protocol, click on the following link: Protocol for a living systematic review for the management of concussion in adults
Procedure for Updating the Guideline for Concussion/Mild Traumatic Brain Injury and Persistent Symptoms: 3rd Edition
To transition from the previous version to the Living Concussion Guidelines, over 40 concussion experts from across North America volunteered to develop the recommendations. Twelve panels covering each major guideline section were created. A minimum of 5 experts were assigned to sections that match their expertise.
All data extractions (summaries for each document and quality assessments), previous recommendations, and full-text copies of each document were first sent to panel experts. These experts were provided with voting options to keep, modify, or delete recommendations based on the relevant evidence. Space to write a revised recommendation and to propose new recommendations was also provided. The expert panels met virtually 1-2 times with a group moderator through a video call to make decisions. Afterwards, results of the meeting(s) were circulated to the entire expert team for feedback. Based on this feedback, the project team made the necessary revisions. Finally, a round of voting (and feedback) occurred with the entire expert team.
Please view the following guideline section update algorithm for more information:
Guideline section update algorithm.pdf
Procedure for Updating the Living Concussion Guidelines
Going forward, the guideline will be potentially updated in the following scenarios:
- When a very important article is published that would likely change assessment or treatment in practice
- When enough articles supporting a particular assessment or treatment technique are published
- Once per year each of the major guideline sections will be reviewed
In each of these scenarios, the project team will send the relevant expert panel the same materials as outlined in the above section. The panel will vote (i.e., keep, modify, or delete) and provide feedback using a survey. 80% approval will be necessary for any major revisions. Afterwards, an optional survey will be sent to the entire expert team for additional feedback.