The currency, completeness and quality of systematic reviews of acute management of moderate to severe traumatic brain injury: A comprehensive evidence map

Synnot, Anneliese; Bragge, Peter; Lunny, Carole; Menon, David K.; Clavisi, Ornella; Pattuwage, Loyal; Volovici, Victor; Mondello, Stefania; Cnossen, Maryse C.; Donoghue, Emma; Gruen, Russell L.; Maas, Andrew I. R.

doi:10.1371/journal.pone.0198676

Cited by 13 publications

(10 citation statements)

References 161 publications

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“…We will search systematic reviews using the Cochrane Library, Excerpta Medica Database (Embase), Epistemonikos,31 PubMed and the International Prospective Register of Systematic Reviews32 from 1990 to up to 6 months prior to submission for publication. Using a snowball approach, we will screen the references of included studies in addition to previous reviews on this subject 7 21–23 33…”

Section: Methods and Analysismentioning

confidence: 99%

“…Interventions and treatment options for acute TBI have been the subject of multiple systematic reviews 21 22. Given this large body of available evidence, evidence maps have previously been used to summarise evidence from systematic reviews on acute TBI interventions 7 23. However, these evidence maps were not designed to target low-value practices and focused on moderate to severe TBI when the mild TBI population represent great potential for reducing low-value care.…”

Section: Introductionmentioning

confidence: 99%

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Low-value clinical practices in adult traumatic brain injury: an umbrella review protocol

et al. 2019

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IntroductionTraumatic brain injury (TBI) leads to 50 000 deaths, 85 000 disabilities and costs $60 billion each year in the USA. Despite numerous interventions and treatment options, the outcomes of TBI have improved little over the last three decades. In a previous scoping review and expert consultation survey, we identified 13 potentially low-value clinical practices in acute TBI. The objective of this umbrella review is to synthesise the evidence on potentially low-value clinical practices in the care of acute TBI.Methods and analysisUsing umbrella review methodology, we will search Cochrane Central Register of Controlled Trials, Embase, Epistemonikos, International Prospective Register of Systematic Reviews (PROSPERO) and PubMed to identify systematic reviews evaluating the effect of potential intrahospital low-value practices using tailored population, intervention, comparator, outcome and study design questions based on the results of a previous scoping review. We will present data on the methodological quality of these reviews (Assessing the Methodological Quality of Systematic Reviews-2), reported effect sizes and strength of evidence (Grading of Recommendations, Assessment, Development and Evaluation).Ethics and disseminationEthics approval is not required as original data will not be collected. Knowledge users from five healthcare quality organisations and clinical associations are involved in the design and conduct of the study. Results will be disseminated in a peer-reviewed journal, at international scientific meetings and to clinical, healthcare quality and patient–partner associations. This work will support the development of metrics to measure the use of low-value practices, inform policy makers on potential targets for deimplementation and in the long term reduce the use of low-value clinical practices in acute TBI care.PROSPERO registration numberCRD42019132428.

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Section: Methods and Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Low-value clinical practices in adult traumatic brain injury: an umbrella review protocol

et al. 2019

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“…Correctness, completeness, and currency are fundamental factors that describe the core concepts of health record data quality: if data is truthful, available, and the most recent available data (149,150).…”

Section: Data Qualitymentioning

confidence: 99%

Characteristics and Impact of U.S. Military Blast-Related Mild Traumatic Brain Injury: A Systematic Review

et al. 2020

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As a result of armed conflict, head trauma from exposure to blasts is an increasing critical health issue, particularly among military service members. Whilst numerous studies examined the burden of blast-related brain injuries on service members', few systematic reviews have been published. This work provides a comprehensive summary of the evidence on blast-related mild traumatic brain injury (mTBI) burden in active U.S. military service members and inactive Veterans, describing characteristics and outcomes. Records published up to April 2017 were identified through a search of PubMed, Web of Science, Scopus, Ovid MEDLINE, and Cochrane Library. Records-based and original research reporting on U.S. military service members and Veterans with mild blast TBI were included. Data on subject characteristics, exposure, diagnostic criterion, and outcomes were extracted from included studies using a standardized extraction form and were presented narratively. Of the 2,290 references identified by the search, 106 studies with a total of 37,515 participants met inclusion criteria for blast-related mTBI. All but nine studies were based out of military or Veteran medical facilities. Unsurprisingly, men were over-represented (75-100%). The criteria used to define blast-related mTBI were consistent; however, the methodology used to ascertain whether individuals met those criteria for diagnosis were inconsistent. The diagnosis, most prevalent among the Army, heavily relied on self-reported histories. Commonly reported adverse outcomes included hearing disturbances and headaches. The most frequently associated comorbidities were post-traumatic stress disorder, depression, anxiety, sleep disorders, attention disorders, and cognitive disorders. The primary objective of this review was to provide a summary of descriptive data on blast-related mTBI in a U.S. military population. Low standardization of the methods for reaching diagnosis and problems in the study reporting emphasize the importance to collect high-quality data to fill knowledge gaps pertaining to blast-related mTBI.

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“…For example, significant bodies of evidence exist concerning the optimum management of patients with traumatic brain injuries or a high total injury burden. [41][42][43] Articles not published in English were excluded from this review which may have introduced bias against evidence from trauma systems in some high-income countries, notably in Europe and South-East Asia. Language bias against lower-to-middle-income countries is likely to be minimal because studies in these settings were explicitly excluded in the review protocol.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Is higher-level trauma center care associated with better outcomes in patients injured by low-energy trauma?

Tonkins¹,

Bradbury²,

Bramley³

et al. 2021

Preprint

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Background In high-income countries trauma patients are becoming older, more likely to have comorbidities, and are being injured by low-energy mechanisms, chiefly ground-level falls. It is currently unknown whether existing trauma systems improve the outcomes of these patients. This systematic review investigates the association between higher-level trauma center care and outcomes of adult patients who were admitted to hospital due to injuries sustained following low-energy trauma. Methods A pre-registered systematic review (CRD42020211652) of subject databases and grey literature, supplemented by targeted manual searching, was conducted in January 2021. Studies were eligible if they reported outcomes in adults admitted to hospital due to low-energy trauma. Studies were excluded if participants were not adults or were not admitted to hospital. Studies in lower- and middle-income settings were excluded due to differences in demographics and healthcare systems. Risk of bias was assessed by independent reviewers using the Robins-I tool. In the presence of study heterogeneity a narrative synthesis was pre-specified. Results Three observational studies were included from 2,898 unique records. The studies' risk of bias was moderate-to-serious due to potential residual confounding and selection bias. All studies compared outcomes among adults injured by ground-level falls treated in trauma centers verified by the American College of Surgeons in the USA. The studies reported divergent results. One demonstrated improved outcomes in level 3 or 4 trauma centers (Observed: Expected Mortality 0.973, 95%CI 0.971-0.975), one demonstrated improved outcomes in level 1 trauma centers (Adjusted Odds Ratio 0.71, 95%CI 0.56-0.91), and one demonstrated no difference between level 1 or 2 and level 3 or 4 trauma center care (Adjusted Odds Ratio 0.91 (0.80-1.04). Conclusions There is currently no strong evidence for the efficacy of major trauma centers in caring for adult patients injured by a ground-level fall. Further studies at lower risk of bias and studies conducted outwith the USA are required.

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The currency, completeness and quality of systematic reviews of acute management of moderate to severe traumatic brain injury: A comprehensive evidence map

Cited by 13 publications

References 161 publications

Low-value clinical practices in adult traumatic brain injury: an umbrella review protocol

Low-value clinical practices in adult traumatic brain injury: an umbrella review protocol

Characteristics and Impact of U.S. Military Blast-Related Mild Traumatic Brain Injury: A Systematic Review

Is higher-level trauma center care associated with better outcomes in patients injured by low-energy trauma?

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