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 * Note: Please use your sandbox to submit assignment # 3 by pasting it below. When uploading your improvements to the article talk page please share your exact proposed edit (not the full assignment 3).


 * Talk Page Template: CARL Medical Editing Initiative/Fall 2019/Talk Page Template

concussion

Assignment #2
November 4, 2019

Kevin Cheung

Wikipedia Literature Search Assignment

Topic: Concussion

1)   How you searched for a source (search strategy – where you went to find it).

I utilized the Trip Database (www.tripdatabase.com) to look for either guidelines or systematic reviews on concussion. I began with a simple generalized search of “concussion” which gave me 3455 results. I further narrowed down my results by limiting it to “All Secondary Evidence” and “Since 2016”, which brought my search results down to 79.

2) What potential sources were identified and considered (give examples of 1 or 2)

There were two potential resources that I identified:

-       “Concussion” BMJ Bets Practice Evidence Based Synopses

-       “Concussion and mild traumatic brain injury” DynaMed Plus Systematic Review

3) Why the source was chosen (what made it better than other choices).

I decided to go with the “Concussion and mild traumatic brain injury” -  Dynamed Systematic Review resource because it was the most focused on the topic at hand. The other available systematic reviews and guideline were more sports specific. I also choose to go with a systematic review rather than a guideline as it would provide me more comprehensive information.

4) List at least three reasons why the source that was selected meets Wikipedia’s reliable medical sources (MEDRS) criteria.

a. Secondary Source that is behind a subscription wall

b. Systematic review = Higher quality evidence

c. Relatively recent resource that has been continually updated, last update was September 2018

d. Scientific Consensus – DynaMed is a clinician-focused tool designed to facilitate efficient and evidence-based patient care

e. No overt biases present/listed

5) How do you plan to use the source for improving the article?

          

I plan to utilize this article as a basis from which to update some of the information in the Wikipedia article. In particular, I am hoping to update information regarding risk factors for concussion and comment on incidence rate/prevalence.

Assignment #3
Article utilized:

McCrory P, Meeuwisse W, Dvorak J, et al

Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of Sports Medicine 2017;51:838-847.

1) Proposed changes:

Original from the 2nd introductory paragraph:

Risk factors include drinking alcohol. The mechanism may involve either a direct blow to the head or forces elsewhere on the body that are transmitted to the head.

I propose the following changes:

Known risk factors for concussion include drinking alcohol, and a prior history of concussion. The mechanism of injury may involve either a direct blow to the head or an impact to the body with force impulses transmitted to the head.

2) Rationale for Proposed Changes:

Sentence 1: “Known risk factors for concussion include drinking alcohol, and a prior history of concussion”

-      As concussion research becomes more prevalent it is important to add in pertinent findings from this research. It is widely known within the rehabilitation world that a history of prior concussion is a risk factor for future concussion, however this fact was not mentioned within the article. I felt as though this is a necessary addition to risk factors for concussion.

-      This additional risk factor was taken from the article “Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016” by P McCrory et al.

-      I believe it was necessary to add in additional consensus risk factors, as having alcohol as the lone risk factor for concussion can be somewhat misleading to a general audience.

-      There were also other risk factors identified throughout the literature, however they were extremely sport specific and I was hesitant to add them to an article written about general concussions.

Sentence 2: “The mechanism of injury may involve either a direct blow to the head or an impact to the body with force impulses transmitted to the head.”

-      I decided to reword this sentence to emphasis the presence of an impact rather than “forces elsewhere” in sustaining a concussion. “Forces elsewhere on the body that are transmitted” is vague and unhelpful in understanding. Changing it to “impact to the body with force impulses transmitted” helps to aid visualization and understanding of other possible mechanisms of injury.

-      This information also came from the article “Consensus statement on concussion in sport…” by P McCrory et al.

3) Potential Area of Controversy

An argument that may come up against my proposed change is the fact that it came from a consensus statement on concussion in sport, which would question the applicability to generalized concussion. That being said, from within the consensus article itself, it states: “lessons derived from non-sporting mTBI research informs the understanding of Sports Related Concussion (and vice versa), and this arbitrary separation of sporting versus non-sporting TBI should not be viewed as a dichotomous or exclusive view of TBI”. Thus, it may be reasonable to conclude that generalizable findings within a sports specific context may be readily applicable to non-sporting concussions scenarios. Although I do hesitate to add any risk factors that are very sport specific, principles that can carry over multiple different sports may very well be generalizable to concussions as a whole.

4) Critique of Source

The purpose of the guideline was clearly stated in the introduction. I did not identify any significant bias and no conflict of interest was declared within this paper. This paper is a consensus statement by The Concussion in Sport Group, which includes a myriad of experts within the field of concussion. It is meant used as a guide to clinical practice. The guideline is a summary of findings from an accompanying systematic review and methodology paper.

Self-assessment of the paper utilizing the AGREE II tool online, I found that it met the majority of criteria listed on the tool, with an average score of 6.4 across all 23 items of assessment.

Regarding Red Flags for clinical guidelines: there were no sponsors identified, no declared conflicts of interests from any of the contributing members, and no suggestion of committee stacking that would pre-ordain a recommendation. There was an accompanying published on the methodology utilized in the systematic review. Where it does fall short is the lack of external review, the paper only mentioned internal peer review; and there was no mention of non-physician experts/patient representative/community stakeholder involvement.

Given that this was an expert consensus-based approach, I could potentially visualize a scenario where the authors/experts could try to force specific perspective upon the readers, however the overall tone of the paper was quite neutral and without favouritism either way. Having a consensus statement from a large panel of experts within the field of concussion may in fact strengthen the information extracted from the article, as one would expect these experts to be much more critical of the information that was appraised and decided upon.