TY - JOUR
T1 - Overview of pharmacological interventions after traumatic brain injuries
T2 - impact on selected outcomes
AU - Kim, Sonya
AU - Mortera, Marianne
AU - Hu, Xiaolei
AU - Krishnan, Shilpa
AU - Hoffecker, Lilian
AU - Herrold, Amy
AU - Terhorst, Lauren
AU - King, Laurie
AU - Machtinger, Joseph
AU - Zumsteg, Jennifer M.
AU - Negm, Ahmed
AU - Heyn, Patricia
N1 - Funding Information:
The authors want to thank the contribution of taskforce members, Drs Zach Bayer and Pallavi Sood, who were critical in different components of the project but could not participate in its entire process. Thank you to Dr. Dawn Ehde for her careful review of this manuscript. This manuscript was developed with the generous support of the American Congress of Rehabilitation Medicine Measurement Networking Group. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Publisher Copyright:
© 2019, © 2019 Taylor & Francis Group, LLC.
PY - 2019/3/21
Y1 - 2019/3/21
N2 - The purpose of this study was to conduct an overview of systematic reviews (SRs) to appraise the published evidence related to pharmacological interventions after traumatic brain injury (TBI). Searches were conducted with Medline, Embase, PsycINFO, Web of Science, PubMed. 780 retrieved SRs underwent a two-level screening to determine inclusion. Data extracted included participant characteristics, TBI severity, study design, pharmacological interventions, and outcomes. SRs were assessed for methodological quality by using the AMSTAR measurement tool. After removing duplicates, 166/780 SRs published between 1990-2017 were reviewed, 62 of which met inclusion criteria. More than 90 drugs and 22 substance-classes were extracted. Most medications were administered during the acute stage. Mild TBI was included in 3% of the SRs. Physiological outcomes comprised 45% of the SRs, primarily mortality. Activities of daily living (ADLs) outcomes constituted 22% of the SRs followed by cognition (13%) and psychological/behavioral outcomes (13%). Only 7% of the SRs assessed adverse events. Inconsistencies in definitions, methods, and heterogeneity of instruments used to measure treatment response were noted. Only a third of the SRs had high methodological quality. Most SRs had heterogeneous TBI samples, outcomes, or methodologies making it difficult to synthesize findings into recommended guidelines. This study demonstrated a need for adequately powered and rigorous randomized clinical trials (RCTs) to provide generalizable evidence on the effectiveness of pharmacologic interventions for TBI. PROSPERO Registration: CRD42015017355.
AB - The purpose of this study was to conduct an overview of systematic reviews (SRs) to appraise the published evidence related to pharmacological interventions after traumatic brain injury (TBI). Searches were conducted with Medline, Embase, PsycINFO, Web of Science, PubMed. 780 retrieved SRs underwent a two-level screening to determine inclusion. Data extracted included participant characteristics, TBI severity, study design, pharmacological interventions, and outcomes. SRs were assessed for methodological quality by using the AMSTAR measurement tool. After removing duplicates, 166/780 SRs published between 1990-2017 were reviewed, 62 of which met inclusion criteria. More than 90 drugs and 22 substance-classes were extracted. Most medications were administered during the acute stage. Mild TBI was included in 3% of the SRs. Physiological outcomes comprised 45% of the SRs, primarily mortality. Activities of daily living (ADLs) outcomes constituted 22% of the SRs followed by cognition (13%) and psychological/behavioral outcomes (13%). Only 7% of the SRs assessed adverse events. Inconsistencies in definitions, methods, and heterogeneity of instruments used to measure treatment response were noted. Only a third of the SRs had high methodological quality. Most SRs had heterogeneous TBI samples, outcomes, or methodologies making it difficult to synthesize findings into recommended guidelines. This study demonstrated a need for adequately powered and rigorous randomized clinical trials (RCTs) to provide generalizable evidence on the effectiveness of pharmacologic interventions for TBI. PROSPERO Registration: CRD42015017355.
KW - Systematic review
KW - meta-analysis
KW - pharmacological interventions
KW - traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=85060927619&partnerID=8YFLogxK
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U2 - 10.1080/02699052.2019.1565896
DO - 10.1080/02699052.2019.1565896
M3 - Article
C2 - 30694081
AN - SCOPUS:85060927619
SN - 0269-9052
VL - 33
SP - 442
EP - 455
JO - Brain Injury
JF - Brain Injury
IS - 4
ER -