Articles: traumatic-brain-injuries.
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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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Patients taking direct oral anticoagulants (DOACs) commonly undergo CT head imaging after minor head injury, regardless of symptoms or signs. However, the risk of intracranial haemorrhage (ICH) in such patients is unclear, and further research has been recommended by the UK National Institute for Health and Care Excellence head injury guideline group. ⋯ The risk of adverse outcome following mild head injury in patients taking DOACs appears low. These findings would support shared patient-clinician decision making, rather than routine imaging, following minor head injury while taking DOACs.
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Review Meta Analysis
Prehospital fluid administration in patients with severe traumatic brain injury: A systematic review and meta-analysis.
Prehospital management of severe traumatic brain injury (TBI) focuses on preventing secondary brain injury. Therefore, hypotension should be prevented, or if present, should be promptly treated in order to maintain optimal cerebral perfusion pressure. Fluid resuscitation is a traditional mainstay in the prehospital treatment of hypotension, however, the choice of fluid type that is to be administered in the prehospital setting is the subject of an on-going debate. This systematic review and meta-analysis was therefore performed to assess the effect of different fluid types on outcome in patients with severe TBI. ⋯ This systematic review and meta-analysis did not demonstrate a survival or neurological benefit for one specific fluid type administered in the prehospital setting.
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Journal of neurotrauma · Oct 2020
Meta AnalysisA systematic review and meta-analysis of hypothermia in experimental traumatic brain injury: why have promising animal studies not been replicated in pragmatic clinical trials?
Therapeutic hypothermia was a mainstay of severe traumatic brain injury (TBI) management for half a century. Recent trials have suggested that its effect on long-term functional outcome is neutral or negative, despite apparently promising pre-clinical data. Systematic review and meta-analysis is a useful tool to collate experimental data and investigate the basis of its conclusions. ⋯ Therapeutic hypothermia appears to be an efficacious treatment in experimental TBI, which differs from the clinical evidence. The pre-clinical literature showed limitations in quality and design and these both appeared to affect neurobehavioral experiment outcome. These should be acknowledged when designing and interpreting pre-clinical TBI studies in the future.
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Review Meta Analysis
Dural Venous Sinus Thrombosis in Patients Presenting with Blunt Traumatic Brain Injuries and Skull Fractures: A Systematic Review and Meta-analysis.
Dural venous sinus thrombosis (DVST) is an increasingly recognized complication of blunt traumatic brain injury (TBI) and skull fractures. However, data concerning epidemiology and clinical significance of DVST are unclear. Determining the disease burden in patients with TBI is an important first step to guide future studies assessing the natural course of traumatic DVST or the effects of its treatment. Therefore, we performed to our knowledge the first systematic review and meta-analysis evaluating the prevalence of DVST in patients with TBI and skull fractures. ⋯ We found an unexpectedly high and consistent frequency of DVST among patients with skull fractures regardless of age group or severity of brain injury. These findings are important and highlight the need for further understanding the natural history of DVST and providing better guidelines on its management.