The currency, completeness and quality of systematic reviews of acute management of moderate to severe traumatic brain injury: A comprehensive evidence map

Anneliese Synnot; Peter Bragge; Carole Lunny; David Menon; Ornella Clavisi; Loyal Pattuwage; Victor Volovici; Stefania Mondello; Maryse C Cnossen; Emma Donoghue; Russell L Gruen; Andrew Maas

doi:10.1371/journal.pone.0198676

The currency, completeness and quality of systematic reviews of acute management of moderate to severe traumatic brain injury: A comprehensive evidence map

PLoS One. 2018 Jun 21;13(6):e0198676. doi: 10.1371/journal.pone.0198676. eCollection 2018.

Authors

Anneliese Synnot^{1

2

3

4}, Peter Bragge⁵, Carole Lunny³, David Menon⁶, Ornella Clavisi^{2

7}, Loyal Pattuwage^{2

8}, Victor Volovici^{9

10}, Stefania Mondello¹¹, Maryse C Cnossen¹², Emma Donoghue¹, Russell L Gruen^{13

14}, Andrew Maas¹⁵

Affiliations

¹ Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
² National Trauma Research Institute, The Alfred, Monash University, Melbourne, Victoria, Australia.
³ Cochrane Australia, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
⁴ Cochrane Consumers and Communication, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia.
⁵ BehaviourWorks Australia, Monash Sustainable Development Institute, Monash University, Melbourne, Victoria, Australia.
⁶ Division of Anaesthesia, University of Cambridge; Neurosciences Critical Care Unit, Addenbrooke's Hospital; Queens' College, Cambridge, United Kingdom.
⁷ MOVE: Muscle, Bone and Joint Health Ltd, Melbourne, Victoria, Australia.
⁸ Monash Centre for Occupational and Environmental Health (MonCOEH), Monash University, Melbourne, Victoria, Australia.
⁹ Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
¹⁰ Department of Neurosurgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
¹¹ Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
¹² Center for Medical Decision Making, Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
¹³ Nanyang Technical University, Singapore.
¹⁴ Central Clinical School, Monash University, Melbourne, Victoria, Australia.
¹⁵ Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium.

Abstract

Objective: To appraise the currency, completeness and quality of evidence from systematic reviews (SRs) of acute management of moderate to severe traumatic brain injury (TBI).

Methods: We conducted comprehensive searches to March 2016 for published, English-language SRs and RCTs of acute management of moderate to severe TBI. Systematic reviews and RCTs were grouped under 12 broad intervention categories. For each review, we mapped the included and non-included RCTs, noting the reasons why RCTs were omitted. An SR was judged as 'current' when it included the most recently published RCT we found on their topic, and 'complete' when it included every RCT we found that met its inclusion criteria, taking account of when the review was conducted. Quality was assessed using the AMSTAR checklist (trichotomised into low, moderate and high quality).

Findings: We included 85 SRs and 213 RCTs examining the effectiveness of treatments for acute management of moderate to severe TBI. The most frequently reviewed interventions were hypothermia (n = 17, 14.2%), hypertonic saline and/or mannitol (n = 9, 7.5%) and surgery (n = 8, 6.7%). Of the 80 single-intervention SRs, approximately half (n = 44, 55%) were judged as current and two-thirds (n = 52, 65.0%) as complete. When considering only the most recently published review on each intervention (n = 25), currency increased to 72.0% (n = 18). Less than half of the 85 SRs were judged as high quality (n = 38, 44.7%), and nearly 20% were low quality (n = 16, 18.8%). Only 16 (20.0%) of the single-intervention reviews (and none of the five multi-intervention reviews) were judged as current, complete and high-quality. These included reviews of red blood cell transfusion, hypothermia, management guided by intracranial pressure, pharmacological agents (various) and prehospital intubation. Over three-quarters (n = 167, 78.4%) of the 213 RCTs were included in one or more SR. Of the remainder, 17 (8.0%) RCTs post-dated or were out of scope of existing SRs, and 29 (13.6%) were on interventions that have not been assessed in SRs.

Conclusion: A substantial number of SRs in acute management of moderate to severe TBI lack currency, completeness and quality. We have identified both potential evidence gaps and also substantial research waste. Novel review methods, such as Living Systematic Reviews, may ameliorate these shortcomings and enhance utility and reliability of the evidence underpinning clinical care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Brain Injuries, Traumatic / therapy*
Evidence-Based Medicine*
Humans
Systematic Reviews as Topic*

Grants and funding

This work was supported by the European Union FP 7th Framework program (Grant 602150). The funder provided support in the form of salary for AS, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. DKM is supported by the National Institute for Health Research (UK). The specific roles of AS and DKM are articulated in the ‘author contributions’ section.