Repeated traumatic brain injury in civilian emergency care: An exploration of potential risk factors.

Repeated traumatic brain injury (rTBI) is recognised as a contributor to long-term impairments in cognition, mental health and quality of life. Whilst most rTBI research has focused on sporting and military populations, rTBI presentations to civilian emergency departments (EDs) remain poorly characterised. For this systematic review, six electronic databases were searched for studies examining TBI and repeat injury (≥2 documented TBIs) in civilian emergency care settings. Study quality was assessed using the Newcastle-Ottawa Scale (NOS). Of 5336 studies obtained using database and manual searching, four met the inclusion criteria. All were observational studies and reported on 301 patients with rTBI, including both adult and paediatric cohorts. Repeated TBI was most commonly observed in individuals with pre-existing alcohol and other drug (AOD) abuse and a history of epilepsy or seizures. Following rTBI, somatic symptoms were most commonly reported, followed by visuo-vestibular symptoms. All included studies were rated as good to high quality (8-9) on the NOS. Confidence in these findings is limited by the small number of eligible studies and heterogeneity of reported outcomes. Given the potential clinical significance of rTBI, a key conclusion is that this is an area for further research to elucidate the causes and effects of rTBI.