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Traumatic Injury and Multiple Sclerosis: A Systematic Review and Meta-Analysis

  • Sharon A. Warren (a1), Susan Armijo Olivo (a2), Jorge Fuentes Contreras (a3) (a4), Karen V. L. Turpin (a5), Douglas P. Gross (a6), Linda J. Carroll (a5) (a7) (a8) and Kenneth G. Warren (a2)...

Abstract

A systematic review/meta-analysis of literature addressing a possible association between traumatic injury and onset of multiple sclerosis was conducted. Medline, Embase, Cochrane DSR, Ovid HealthStar, CINAHL, ISI Web of Science and Scopus were searched for analytical studies from 1950 to 2011. Two investigators independently reviewed articles for inclusion, assessing their quality using the Newcastle-Ottawa Scale. Of the 13 case-control studies included, 8 were moderate quality and 5 low; of the 3 cohort studies 2 were high and 1 moderate. Meta-analysis including moderate and low quality case-control studies produced a modest but significant odds ratio: 1.41 (95% confidence interval: 1.03, 1.93). However, when low quality studies were excluded, the resulting odds ratio was non-significant. Cohort studies produced a non-significant standardized incidence ratio of 1.00 (95% confidence interval: 0.86, 1.16). These findings support the conclusion that there is no association between traumatic injury and multiple sclerosis onset; more high quality cohort studies would help to confirm this observation.

RÉSUMÉ

Nous avons effectuéne revue systétique de la littéture et une mé-analyse sur une association possible entre un traumatisme et le dét de la sclése en plaques (SP). Nous avons recherchées édes analytiques publié de 1950 à011 dans Medline, Embase, Cochrane DSR, Ovid HealthStar, CINAHL, ISI Web of Science et Scopus. Deux chercheurs ont résée faç indéndante les articles et éluéeur qualitéu moyen de l'éelle Newcastle-Ottawa. Parmi les 13 édes cas-téin que nous avons retenues, 8 éient de qualitéoyenne et 5 de qualitééocre, alors que parmi les 3 édes de cohorte, 2 éient de haute qualitét 1 de qualitéoyenne. Le rapport de cotes obtenu de la mé-analyse qui incluait des édes cas-téin de qualitéoyenne et méocre éit modeste mais significatif : 1,41 (intervalle de confiance à5% : 1,03 à,93). Cependant, quand nous avons exclu de l'analyse les édes de qualitééocre, le rapport de cotes n'éit pas significatif. Le taux d'incidence standardiséour les édes de cohorte éit de 1,00 (IC à5% : 0,86 à,16), donc non significatif. Ces observations indiquent qu'il n'existe pas d'association entre un traumatisme et le dét de la sclése en plaques. D'autres édes de cohorte de haute qualitéideraient àonfirmer cette observation.

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Copyright

Corresponding author

Rehabilitation Research Centre, University of Alberta, Edmonton, Alberta, Canada. Email: sharon.warren@ualberta.ca.

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