Journal of neurotrauma
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Journal of neurotrauma · Dec 2020
ReviewLOW-VALUE CLINICAL PRACTICES IN ADULT TRAUMATIC BRAIN INJURY: AN UMBRELLA REVIEW.
Despite numerous interventions and treatment options, the outcomes of traumatic brain injury (TBI) have improved little over the last 3 decades, which raises concern about the value of care in this patient population. We aimed to synthesize the evidence on 14 potentially low-value clinical practices in TBI care. Using umbrella review methodology, we identified systematic reviews evaluating the effectiveness of 14 potentially low-value practices in adults with acute TBI. ⋯ For the following practices, effect estimates were consistently close to the null: computed tomography (CT) in adults with mild TBI who are low-risk on a validated clinical decision rule; repeat CT in adults with mild TBI on anticoagulant therapy with no clinical deterioration; antibiotic prophylaxis for external ventricular drain placement; and decompressive craniectomy for refractory intracranial hypertension. We identified five clinical practices with evidence of lack of benefit or harm. However, evidence could not be considered to be strong for any clinical practice as effect measures were imprecise and heterogeneous, systematic reviews were often of low quality, and most included studies had a high risk of bias.
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Journal of neurotrauma · Dec 2020
Meta AnalysisNon-invasive techniques for multimodal monitoring in Traumatic Brain Injury (TBI): systematic review and meta-analysis.
Monitoring brain oxygenation and intracranial pressure non-invasively and continuously is of paramount importance in traumatic brain injury (TBI). The primary motivation of this study was to identify and provide robust evidence of the most effective techniques for the non-invasive multimodal monitoring for traumatic brain injury. Two reviewers independently searched PubMed, Embase, Scopus, the Cochrane Library, and the Web of Science between January 15, 2010, and January 22, 2020. ⋯ A meta-analysis on non-invasive ICP monitoring revealed a strong pooled correlation coefficient of 0.725 (95 % confidence interval [CI]: 0.450-0.874; I2 91.31%) between transcranial Doppler and the gold standard ICP monitoring. The current meta-analysis has shown that the two most prominent and widely used technologies for non-invasive monitoring in TBI are near-infrared spectroscopy and transcranial Doppler. Both techniques could be considered for the future development of a single non-invasive and continuous multimodal monitoring device for TBI.
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Journal of neurotrauma · Dec 2020
ReviewBeyond binary: the influence of sex and gender on outcome after traumatic brain injury.
Traumatic brain injury (TBI) affects millions of individuals each year and is a leading cause of death and disability worldwide. TBI is heterogeneous and outcome is influenced by a combination of factors that include injury location, severity, genetics, and environmental factors. More recently, sex as a biological variable has been incorporated into TBI research, although there is conflicting literature regarding clinical outcomes in males versus females after TBI. ⋯ Social constructs regarding gender impact an individual's vulnerability to violence and consequent TBI, including the successful reintegration to society after TBI. We call for incorporation of gender beyond the binary in TBI education, research, and clinical care. Precision medicine necessarily must progress beyond the binary to treat individuals after TBI.