Personal Injury Law

Binder's Mild Traumatic Brain Injury Meta-Analysis Refuted

By Bruce Stern

Defense attorneys and their courtroom doctors often rely on the Mild Traumatic Brain Injury meta-analyses conducted by Binder, Rohling and Larrabee and updated by Frencham, Fox and Maybery (2005) to argue that mild traumatic brain injury has no lasting effect on neuropsychological status. 
 
Most recently, Erin D. Bigler, along with Jon L. Pertab and James M. Kelly reanalyzed the meta-analytic data sets utilized by Binder and Frencham.
 
This new study published in Brain Injury (June 2009; 23(6):498-508) revisited the data combined in the meta analyses of Binder et al and Frencham et al, specifically addressing four areas: (1) mechanism of injury, (2) diagnostic criteria employed, (3) type of neuropsychological assessment to employ and (4) whether symptomatic or nonsymptomatic MTBI subjects were assessed separately.
 
After reviewing all of the studies utilized by Binder and Frencham, Bigler et al stated:
 
 As indicated in the introduction, the Binder et al and Frencham et al studies have been cited to support the non-effect of any lasting sequelae of MTBI as a general principle for the outcome of all MTBIs.  From the total group standpoint, that likely remains a true statement but not one that necessarily applies to an individual within that sample.
 
The authors conclude that since the Binder and Frencham meta-analyses only employed 25 articles in the meta-analysis, while the National Library of Medicine now lists more than a 100 mild TBI articles published since 2005 that examine neuropsychological outcome in mild TBI cases, 'there should now be sufficient sample size to utilize meta-analytic techniques to better answer the residual and neurobehavioral effects of having sustained an MTBI by controlling for and examining the variables identified in this critique.'
 
This new study analyzing and recognizing the limitations of mild TBI meta-analyses by both Binder et al and Frencham et al will help dis-spell the notion and testimony of defense courtroom neuropsychologists and other medical doctors that everyone recovers from mild traumatic brain injuries. Clearly this study refutes that argument.

Full post as published by Traumatic Brain Injury Law Blog on August 14, 2009 (boomark / email).