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

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Helmy, Adel 
Belli, Antonio 
Ganau, Mario 


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.


Peer reviewed: True

Acknowledgements: We would like to thank Love of the Game for their support with this work. Peter Hutchinson would also like to thank the NIHR Senior Investigator Award, Cambridge Biomedical Research Centre, Medtech Brain Injury Co-operative, Global Health Research Group on Acquired Brain and Spine Injury and Royal College of Surgeons of England. AH is supported by the Cambridge Biomedical Research Campus, the Royal College of Surgeons of England, and is a Theme Lead in the NIHR Brain Injury MedTech Collaborative.


neurological injury, patient-centered care, public health, Child, Humans, Brain Concussion, Prognosis, Critical Pathways, England, Delphi Technique, Delivery of Health Care

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BMJ Open

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