Citation

Lei J, Gao G, Jiang J. J. Neurotrauma 2013; 30(7): 529-537.

Affiliation

Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, ShangHai, China; smiles1949@163.com.

Copyright

(Copyright © 2013, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2012.2548

PMID

23151044

Abstract

Traumatic brain injury (TBI) is a major health and socioeconomic problem worldwide for the high rate of death and long-term disability. Prior studies have summarized evidence from large scale randomized trials, finding no intervention shown convincing efficacy for acute TBI management. The present empirical study set out to assess another crucial component of evidence base - systematic review, which contributes a lot to evidence-based healthcare, in terms of clinical issues, methodological aspects and implication for practice and research. A total of 44 systematic reviews pertaining to therapeutic interventions for acute TBI were identified through electronic database searching, clinical guideline retrieval and expert consultation, of them 21 published in Cochrane Library and 23 in peer-reviewed journals. Their methodological quality was generally satisfactory with the median OQAQ score of 5.5 (Inter-quartile range: 2 -7). Cochrane reviews are of better quality than regular journal reviews. Twenty-nine high quality reviews provided no conclusive evidence for the investigated twenty-two interventions except Corticosteroids. Only less than one third of the component trials were reported with adequate allocation concealment. Besides, some other methodological flaws in design, for instance, ignoring heterogeneity among TBI population, together contributed to the failure of past clinical research. Based on the above findings, hence, evidence both from systematic reviews and clinical trials seems lacking the potential to support current management of acute traumatic brain injury. Translating from laboratory success to clinical effect remains a unique challenge. It might be the time to rethink the way in future practice and clinical research in TBI.

Language: en