Pharmacological interventions in traumatic brain injury: Can we rely on systematic reviews for evidence?

Riza Gultekin; Sean Huang; Ornella Clavisi; Loyal Pattuwage; Thomas C König; Russell Gruen

doi:10.1016/j.injury.2015.10.011

Pharmacological interventions in traumatic brain injury: Can we rely on systematic reviews for evidence?

Injury. 2016 Mar;47(3):516-24. doi: 10.1016/j.injury.2015.10.011. Epub 2015 Oct 24.

Authors

Riza Gultekin¹, Sean Huang², Ornella Clavisi³, Loyal Pattuwage³, Thomas C König⁴, Russell Gruen⁵

Affiliations

¹ Alfred Health, Melbourne 3004, Vic, Australia; National Trauma Research Institute, Vic, Australia; Queen Mary University of London and Barts and The London School of Medicine and Dentistry, London, UK. Electronic address: riz.gultekin@gmail.com.
² Alfred Health, Melbourne 3004, Vic, Australia.
³ National Trauma Research Institute, Vic, Australia.
⁴ Queen Mary University of London and Barts and The London School of Medicine and Dentistry, London, UK.
⁵ Alfred Health, Melbourne 3004, Vic, Australia; National Trauma Research Institute, Vic, Australia.

PMID: 26589595
DOI: 10.1016/j.injury.2015.10.011

Abstract

Introduction: Providing current, reliable and evidence based information for clinicians and researchers in a synthesised and summarised way can be challenging particularly in the area of traumatic brain injury where a vast number of reviews exists. These reviews vary in their methodological quality and are scattered across varying sources. In this paper, we present an overview of systematic reviews that evaluate the pharmacological interventions in traumatic brain injury (TBI). By doing this, we aim to evaluate the existing evidence for improved outcomes in TBI with pharmacological interventions, and to identify gaps in the literature to inform future research.

Methods: We searched the Neurotrauma Evidence Map on systematic reviews relating to pharmacological interventions for managing TBI in acute phase. Two reviewers independently screened search results and appraised each systematic review using the validated AMSTAR tool and extracted data from the review.

Results: A total of 288 systematic reviews relating to TBI were available on the Neurotrauma Evidence Map at the time of this study. We identified 19 systematic reviews on pharmacological management for acute TBI with publications dates ranging from 1998 to 2014. The studies were of varying methodological quality, with a mean AMSTAR score of 7.78 (range 2-11].

Conclusion: The evidence from high quality systematic reviews show that there is currently insufficient evidence for the use of magnesium, monoaminergic and dopamine agonists, progesterone, aminosteroids, excitatory amino acid inhibitors, haemostatic and antifibrinolytic drugs in TBI. Anti-convulsants are only effective in reducing early seizures with no significant difference between phenytoin and leviteracetam. There is no difference between propofol and midazolam for sedation in TBI patients and ketamine may not cause increased ICP. Overviews of systematic review provide informative and powerful summaries of evidence based research.

Keywords: Acute brain injury; Evidence-based medicine; Pharmacology; Systematic review; Trauma.

Publication types

Review
Systematic Review

MeSH terms

Anticonvulsants / therapeutic use*
Biomedical Research / trends
Brain Injuries, Traumatic / drug therapy*
Brain Injuries, Traumatic / physiopathology
Brain Injuries, Traumatic / rehabilitation
Dopamine Agonists / therapeutic use*
Evidence-Based Medicine*
Humans
Hypnotics and Sedatives / therapeutic use*
Progesterone / therapeutic use*

Substances

Anticonvulsants
Dopamine Agonists
Hypnotics and Sedatives
Progesterone