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Is management of acute traumatic brain injury effective? A literature review of published Cochrane Systematic Reviews.
MedLine Citation:
PMID:  22300914     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Objective: To evaluate all the possible therapeutic measures concerning the acute management of traumatic brain injury (TBI) mentioned in Cochrane Systematic Reviews published in the Cochrane Database of Systematic Reviews (CDSR). Methods: An exhausted literature search for all published Cochrane Systematic Reviews discussing therapeutic rather than prevention or rehabilitative interventions of TBI was conducted. We retrieved such databases as CDSR and Cochrane Injury Group, excluded the duplications, and eventually obtained 20 results, which stand for critical appraisal for as many as 20 different measures for TBI patients. The important data of each systematic review, including total population, intervention, outcome, etc, were collected and presented in a designed table. Besides, we also tried to find out the possible weakness of these clinical trials included in each review. Results: Analysis of these reviews yielded meanfuling observations: (1) The effectiveness of most ordinary treatments in TBI is inconclusive except that corticosteroids are likely to be ineffective or harmful, and tranexamic acid, nimodipine and progesterone show a promising effect in bleeding trauma, traumatic subarachnoid hemorrhage, TBI or severe TBI. (2) A majority of the systematic reviews include a small number of clinical trials and the modest numbers of patients, largely due to the uncertainty of the effectiveness. (3) The quality of most trials reported in the systematic reviews is more or less questionable. (4) In addition, lots of other complex factors together may lead to the inconclusive results demonstrated in the Cochrane Systematic Reviews. Conclusions: For clinical physicians, to translate these conclusions into practice with caution is essential. Basic medication and nursing care deserve additional attention as well and can be beneficial. For researchers, high quality trials with perfect design and comprehensive consideration of various factors are urgently required.
Authors:
Jin Lei; Guo-Yi Gao; Ji-Yao Jiang
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Chinese journal of traumatology = Zhonghua chuang shang za zhi / Chinese Medical Association     Volume:  15     ISSN:  1008-1275     ISO Abbreviation:  Chin. J. Traumatol.     Publication Date:  2012 Feb 
Date Detail:
Created Date:  2012-02-03     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100886162     Medline TA:  Chin J Traumatol     Country:  China    
Other Details:
Languages:  eng     Pagination:  17-22     Citation Subset:  IM    
Affiliation:
Neurosurgery Department of Renji Hospital, Medical School of Shanghai JiaoTong University, Shanghai Institute of Head Trauma, Shanghai 200127, China.
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