Overview of pharmacological interventions after traumatic brain injuries: impact on selected outcomes.

a Department of Neurology and Department of Rehabilitation Medicine , NYU School of Medicine , New York , USA. b NYU Steinhardt, Department of Occupational Therapy , New York University , New York , USA. c Department of Community Medicine and Rehabilitation , UmeƄ University , Sweden. d Department of Rehabilitation Medicine, Division of Physical Therapy , Emory University , Atlanta , Georgia , USA. e Health Sciences Library , University of Colorado Anschutz Medical Campus , Aurora , Colorado , USA. f Center of Innovation for Complex Chronic Healthcare , Edward Hines Jr., VA Hospital , Hines , Illinois , USA. g Department of Occupational Therapy, School of Health and Rehabilitation Services , University of Pittsburgh , Pittsburgh , Pennsylvania , USA. h Neurology , Oregon Health & Science University , Portland , Oregon , USA. i Department of Neurology, Division of Multiple Sclerosis , University of Colorado School of Medicine , Aurora , Colorado , USA. j Department of Rehabilitation Medicine , University of Washington , Seattle , Washington , USA. k School of Rehabilitation Sciences , McMaster University , Hamilton , Ontario , USA. l Department of Physical Medicine and Rehabilitation , University of Colorado Anschutz Medical Campus , Aurora , Colorado , USA.

Brain injury. 2019;(4):442-455
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Abstract

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.

Methodological quality

Publication Type : Review

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