Early or late cranioplasty following decompressive craniotomy for traumatic brain injury: A systematic review and meta-analysis

Objective To evaluate the effectiveness of early (<3 months) cranioplasty (CP) and late CP (>3 months) on post-operative complications in patients receiving decompressive craniotomy (DC) for traumatic brain injury (TBI). Methods The Cochrane Library, PubMed and EMBASE databases were systematically searched for studies published prior to May 21, 2017. A meta-analysis examined post-operative overall complication rates, infection rates, subdural fluid collection and operating times according to early and late CP. Results Of the initial 1675 references, five studies, all cohort, involving a total of 413 patients, were selected for the review. There was no difference between early and late CP in post-operative overall complication rate (RR=0.68, 95%CI [0.36, 1.29]) and the post-operative infection rate (RR=0.50, 95%CI [0.20, 1.24]) in patients receiving DC for TBI. However, there was a significant difference in post-operative subdural effusion (RR=0.24, 95%CI [0.07, 0.78]) and mean operative time (mean difference = −33.02 min, 95%CI [−48.19, −17.84]) both in favour of early CP. Conclusions No differences were found between early and late CP in post-operative overall complications and procedural related infections in patients receiving DC for TBI, but early CP reduced the complication of subdural effusion and the mean operating time. These findings need to be confirmed by large, randomised controlled trials.

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Potential Efficacy of Erythropoietin on Reducing the Risk of Mortality in Patients with Traumatic Brain Injury: A Systematic Review and Meta-Analysis

BioMed Research International ◽

10.1155/2020/7563868 ◽

2020 ◽

Vol 2020 ◽

pp. 1-9

Author(s):

Chengli Liu ◽

Changsheng Huang ◽

Jie Xie ◽

Hui Li ◽

Michael Hong ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Meta Analysis ◽

Risk Difference ◽

Neurological Function ◽

Cochrane Library ◽

Chi Square ◽

Vein Thrombosis ◽

Risk Of Mortality ◽

Significant Difference

Objective. The objective of this study is to assess the effectiveness of erythropoietin (EPO) on mortality, neurological outcomes, and adverse event in the treatment of traumatic brain injury (TBI). Methods. We searched databases including PubMed, OVID, and the Cochrane Library from inception until October 18, 2019 for randomized controlled trials (RCTs) to compare EPO treatment group and placebo in patients with TBI. Two authors independently processed the data and evaluated the quality of inclusion studies. Statistical analysis was performed with heterogeneity test with I 2 and chi-square tests. We summarized the mortality, prognosis of neurological function, and deep vein thrombosis (DVT) outcomes and presented as risk ratio (RR) or risk difference (RD) with a 95% CI. Results. Seven RCTs accounting for 1180 patients were included after meeting the inclusion criteria. Compared with placebo, the overall mortality of EPO-treated patients was significantly reduced (RR 0.68 [95% CI 0.50-0.93]; p = 0.02 ). EPO therapy did not improve neurological prognosis (RR 1.21 [95% CI 0.93-1.15]; p = 0.16 ) or increase the occurrence of DVT (RR 0.83 [95% CI 0.61–1.13]; p = 0.242 ), which showed no significant difference. Conclusions. The results showed that the administration of EPO may reduce the risk of mortality without enhancing the occurrence of DVT in TBI patients. However, the effect of EPO on neurological outcome remains indistinct. Through subgroup analysis, we demonstrated that the dose of EPO may be a potential factor affecting the heterogeneity in neurological function and that the follow-up duration may influence the stability of the result.

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Therapeutic effect of erythropoietin in patients with traumatic brain injury: a meta-analysis of randomized controlled trials

Journal of Neurosurgery ◽

10.3171/2016.4.jns152909 ◽

2017 ◽

Vol 127 (1) ◽

pp. 8-15 ◽

Cited By ~ 11

Author(s):

Wen-Chao Liu ◽

Liang Wen ◽

Tao Xie ◽

Hao Wang ◽

Jiang-Biao Gong ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

Randomized Controlled ◽

Hospitalization Time ◽

Statistical Heterogeneity ◽

Significant Difference

OBJECTIVEErythropoietin (EPO) exerts a neuroprotective effect in animal models of traumatic brain injury (TBI). However, its effectiveness in human patients with TBI is unclear. In this study, the authors conducted the first meta-analysis to assess the effectiveness and safety of EPO in patients with TBI.METHODSIn December 2015, a systematic search was performed of PubMed, Web of Science, MEDLINE, Embase, the Cochrane Library databases, and Google Scholar. Only English-language publications of randomized controlled trials (RCTs) using EPO in patients with TBI were selected for analysis. The assessed outcomes included mortality, favorable neurological outcome, hospital stay, and associated adverse effects. Continuous variables were presented as mean difference (MD) with a 95% confidence interval (CI). Dichotomous variables were presented as risk ratio (RR) or risk difference (RD) with a 95% CI. Statistical heterogeneity was examined using both I2 and chi-square tests.RESULTSOf the 346 studies identified in the search, 5 RCTs involving 915 patients met the inclusion criteria. The overall results demonstrated that EPO significantly reduced mortality (RR 0.69, 95% CI 0.49–0.96, p = 0.03) and shortened the hospitalization time (MD −7.59, 95% CI −9.71 to −5.46, p < 0.0001) for patients with TBI. Pooled results of favorable outcome (RR 1.00, 95% CI 0.88–1.15, p = 0.97) and deep vein thrombosis (DVT; RD 0.00, 95% CI −0.05 to 0.05, p = 1.00) did not show a significant difference.CONCLUSIONSThe authors suggested that EPO is beneficial for patients with TBI in terms of reducing mortality and shortening hospitalization time without increasing the risk of DVT. However, its effect on improving favorable neurological outcomes did not reach statistical significance. Therefore, more well-designed RCTs are necessary to ascertain the optimum dosage and time window of EPO treatment for patients with TBI.

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Endoscopic versus Surgical Intervention for Painful Obstructive Chronic Pancreatitis: A Systematic Review and Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm10122636 ◽

2021 ◽

Vol 10 (12) ◽

pp. 2636

Author(s):

Ka Wing Ma ◽

Hoonsub So ◽

Euisoo Shin ◽

Janice Hoi Man Mok ◽

Kim Ho Kam Yuen ◽

...

Keyword(s):

Chronic Pancreatitis ◽

Pain Relief ◽

Meta Analysis ◽

Small Sample ◽

Cochrane Library ◽

Endoscopic Drainage ◽

Complication Rates ◽

Surgical Drainage ◽

Endocrine Insufficiency ◽

Significant Difference

There is limited evidence on the standard care for painful obstructive chronic pancreatitis (CP), while comparisons of endoscopic and surgical modes for pain relief have yielded conflicting results from small sample sizes. We aimed to obtain a clear picture of the matter by a meta-analysis of these results. We searched the Pubmed, Embase, and Cochrane Library databases to identify studies comparing endoscopic and surgical treatments for painful obstructive CP. Pooled effects were calculated by the random effect model. Primary outcomes were overall pain relief (complete and partial), and secondary outcomes were complete and partial pain relief, complication rate, hospitalization duration, and endocrine insufficiency. Seven studies with 570 patients were included in the final analysis. Surgical drainage was associated with superior overall pain relief [OR 0.33, 95% CI 0.23–0.47, p < 0.001, I2 = 4%] and lesser incidence of endocrine insufficiency [OR 2.10, 95% CI 1.20–3.67, p = 0.01, I2 = 0%], but no significant difference in the subgroup of complete [OR 0.57, 95% CI 0.32–1.01, p = 0.054, I2 = 0%] or partial [OR 0.67, 95% CI 0.37–1.22, p = 0.19, I2 = 0%] pain relief, complication rates [OR 1.00, 95% CI 0.41–2.46, p = 0.99, I2 = 49%], and hospital stay [OR −0.54, 95% CI −1.23–0.15, p = 0.13, I2 = 87%] was found. Surgery is associated with significantly better overall pain relief and lesser endocrine insufficiency in patients with painful obstructive CP. However, considering the invasiveness of surgery, no significant differences in complete or partial pain relief, and heterogeneity of a few parameters between two groups, endoscopic drainage may be firstly performed and surgical drainage may be considered when endoscopic drainage fails.

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Assessment of Prophylactic Carbapenem Antibiotics Administration for Severe Acute Pancreatitis: An Updated Systematic Review and Meta-Analysis

Digestion ◽

10.1159/000520892 ◽

2022 ◽

pp. 1-9

Author(s):

Daxin Guo ◽

Wei Dai ◽

Jingyi Shen ◽

Mengting Zhang ◽

Yetan Shi ◽

...

Keyword(s):

Acute Pancreatitis ◽

Organ Failure ◽

Severe Acute Pancreatitis ◽

Pancreatic Pseudocyst ◽

Meta Analysis ◽

Fluid Collection ◽

Cochrane Library ◽

Intensive Care Unit Treatment ◽

Significant Difference ◽

And Control

Background: The effectiveness of prophylactic antibiotics in severe acute pancreatitis (SAP) remains a debatable issue. This meta-analysis aimed to determine the efficacy of prophylactic carbapenem antibiotics in SAP. Methods: This meta-analysis of prophylactic carbapenem antibiotics for SAP was conducted in PubMed, EMBASE, Web of Science, MEDLINE, and Cochrane Library up to February 2021. The related bibliographies were manually searched. The primary outcomes involved infected pancreatic or peripancreatic necrosis, mortality, complications, infections, and organ failure. Results: Seven articles comprised 5 randomized controlled trials and 2 retrospective observational studies, including 3,864 SAP participants. Prophylactic carbapenem antibiotics in SAP were associated with a statistically significant reduction in the incidence of infections (odds ratio [OR]: 0.27; p = 0.03) and complications (OR: 0.48; p = 0.009). Nevertheless, no statistically significant difference was demonstrated in the incidence of infected pancreatic or peripancreatic necrosis (OR: 0.74; p = 0.24), mortality (OR: 0.69; p = 0.17), extrapancreatic infection (OR: 0.64, p = 0.54), pulmonary infection (OR: 1.23; p = 0.69), blood infection (OR: 0.60; p = 0.35), urinary tract infection (OR: 0.97; p = 0.97), pancreatic pseudocyst (OR: 0.59; p = 0.28), fluid collection (OR: 0.91; p = 0.76), organ failure (OR: 0.63; p = 0.19), acute respiratory distress syndrome (OR: 0.80; p = 0.61), surgical intervention (OR: 0.97; p = 0.93), dialysis (OR: 2.34; p = 0.57), use of respirator or ventilator (OR: 1.90; p = 0.40), intensive care unit treatment (OR: 2.97; p = 0.18), and additional antibiotics (OR: 0.59; p = 0.28) between the experimental and control groups. Conclusions: It is not recommended to administer routine prophylactic carbapenem antibiotics in SAP.

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Reconstruction Methods and Complications of Esophagogastrostomy and Jejunal Interposition in Proximal Gastrectomy for Gastric Cancer: A Meta-Analysis

Gastroenterology Research and Practice ◽

10.1155/2020/8179254 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Nan Du ◽

Pei Wu ◽

Pengliang Wang ◽

Yuwei Du ◽

Kai Li ◽

...

Keyword(s):

Gastric Cancer ◽

Lower Risk ◽

Meta Analysis ◽

Proximal Gastrectomy ◽

Operating Time ◽

Perioperative Period ◽

Jejunal Interposition ◽

Cochrane Library ◽

Reconstruction Methods ◽

Significant Difference

Background. Proximal gastrectomy is used for the treatment of primary gastric cancer by open or laparoscopic surgery in the upper third of the stomach. Esophagogastrostomy (EG) or jejunal interposition (JI) is widely used in various reconstruction methods after proximal gastrectomy. We conducted a meta-analysis of EG and JI for treatment of gastric cancer. Materials and Methods. A search of PubMed, Embase, MEDLINE, J-STAGE, and Cochrane Library identified retrospective series on EG and JI. Weight mean differences (WMDs), odds ratios (ORs), and 95% confidence intervals (CIs) were used to analyze the operation-related data and postoperative complications. Heterogeneity was evaluated by the I2 test, and potential publication bias was assessed with Egger regression tests and sensitivity analysis. Results. Eight studies were selected, and 496 patients were included. EG group benefits were 44.81 min shorter operating time (P<0.001), 56.58 mL less blood loss (P=0.03), and 7.4 days shorter hospital stay time (P<0.001) than the JI group. Between the two groups, there was no significant difference in anastomotic leakage; otherwise, the EG group had a lower risk of anastomotic stenosis (OR=0.44, 95%CI=0.20 to 0.97, P=0.04), lower risk of intestinal obstruction (OR=0.07, 95%CI=0.01 to 0.43, P=0.004), and higher risk of reflux esophagitis (OR=2.47, 95%CI=1.07 to 5.72, P=0.03). Conclusion. The results of our study indicated that EG has significant advantages during the perioperative period and in short-term outcomes compared to JI.

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Mannitol cannot reduce the mortality on acute severe traumatic brain injury (TBI) patients: a meta–analyses and systematic review

Burns & Trauma ◽

10.1186/s41038-015-0006-8 ◽

2015 ◽

Vol 3 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Kai Wang ◽

Mingwei Sun ◽

Hua Jiang ◽

Xiao-ping Cao ◽

Jun Zeng

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Brain Injuries ◽

Meta Analysis ◽

Outcome Data ◽

Control Treatment ◽

Current Evidence ◽

Cochrane Library

Abstract Background We aimed to systematically review the efficacy of mannitol (MTL) on patients with acute severe traumatic brain injury (TBI). Methods Databases such as PubMed (US National Library of Medicine), CENTRAL (The Cochrane Library 2014, Issue 3), ISI (Web of Science: Science Citation Index Expanded), Chinese Biomedicine Database (CBM), and China Knowledge Resource Integrated Database (CNKI) have been searched for relevant studies published between 1 January 2003 and 1 October 2014. We have established inclusion and exclusion criteria to identify RCTs, which were suitable to be enrolled in the systematic review. The comparison group could be hypertonic saline (HS), hydroxyethyl starch, or others. The quality assessment was based on the Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 and modified Jadad score scale. The major outcome was mortality, followed by the secondary outcomes such as neurological outcome, days on intensive care unit (ICU), and ventilator day. In addition, intracranial pressure (ICP), cerebral perfusion pressure (CPP), and mean arterial pressure (MAP) were used as the surrogate endpoints. Data synthesis and meta-analysis was conducted by using R (version 3.7-0.). Results When 176 potential relevant literatures and abstracts have been screened, four RCTs met all the inclusion criteria and were enrolled for the meta-analysis. Amongst all the enrolled studies, two trials have provided the primary outcome data. There was no heterogeneity between two studies (I2 = 0 %) and a fixed model was used for meta-analysis (n = 53), pooled result indicated that the mortality was similar in mannitol intervention and control treatment, OR = 0.80, 95 % CI [0.27, 2.37], P = 0.38. We found that both mannitol and HS were efficient in decreasing the ICP. Furthermore, the effect of the HS on the ICP appeared to be more effective in the patients with diffuse brain injuries than mannitol did. Conclusions As a conclusion, the mannitol therapy cannot reduce the mortality risk of acute severe traumatic brain injury. Current evidence does not support the mannitol as an effective treatment of acute severe traumatic brain injury. The well-designed randomized controlled trials are in urgent need to demonstrate the adoption of mannitol to acute severe traumatic brain injury.

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Immunonutrition for traumatic brain injury in children and adolescents: protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2020-037014 ◽

2020 ◽

Vol 10 (9) ◽

pp. e037014

Author(s):

Rong Peng ◽

Hailong Li ◽

Lijun Yang ◽

Xinwei Chen ◽

Linan Zeng ◽

...

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Evaluation Method ◽

Clinical Decision Making ◽

Meta Analysis ◽

Risk Of Bias ◽

Cochrane Library ◽

Published Data ◽

Pool Data

IntroductionTraumatic brain injury (TBI) is the leading cause of paediatric trauma death and disability worldwide. The ‘Guidelines for the Management of Severe Traumatic Brain Injury (Fourth Edition)’ recommend that nutritional goals should be achieved within 5–7 days of injury. Immune-enhancing nutrition or immunonutrition, referring to the addition of specialised nutrients, including glutamine, alanine, omega-3 fatty acids and nucleotides, to standard nutrition formulas, may improve surgical outcomes in the perioperative period. However, the role of immune-enhancing nutritional supplements for patients with paediatric TBI remains unclear. We will conduct a systematic review to determine the efficacy and safety of immunonutrition for patients with paediatric TBI and provide evidence for clinical decision-making.Methods and analysisStudies reporting immune-enhancing nutrition treatments for patients with paediatric TBI will be included. Outcomes of interest include the length of hospital stay, wound infections, all-cause mortality, non-wound infection, including pneumonia, urinary tract infection and bacteraemia, and the reports adverse events. Duration of follow-up has no restriction. Primary studies consisting of randomised controlled trials (RCTs) and non-RCTs will be eligible for this review, and only studies published in English will be included. We will search the Medline, Embase and Cochrane Library databases from their inception dates to January 2020. We will also search clinicaltrials.gov and the WHO International Clinical Trials Registry Platform for additional information. Two reviewers will independently select studies and extract data. Risk-of-bias will be assessed with tools based on the Cochrane risk-of-bias criteria and Newcastle-Ottawa Quality Assessment Scale. A meta-analysis will be used to pool data when there are sufﬁcient studies with homogeneity. Heterogeneity of the estimates across studies will be assessed; if necessary, a subgroup analysis will be performed to explore the source of heterogeneity. The Grades of Recommendation, Assessment, Development and Evaluation method will be applied to assess the level of evidence obtained from this systematic review.Ethics and disseminationThe proposed systematic review and meta-analysis will be based on published data, and thus ethical approval is not required. The results of this review will be published.PROSPERO registration numberCRD42020154814.

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S100B Serum Level as a Mortality Predictor for Traumatic Brain Injury: A Meta-Analysis

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2018.432 ◽

2018 ◽

Vol 6 (11) ◽

pp. 2239-2244 ◽

Cited By ~ 2

Author(s):

Nyoman Golden ◽

Tjokorda Gde Bagus Mahadewa ◽

Citra Aryanti ◽

I Putu Eka Widyadharma

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Meta Analysis ◽

Head Injuries ◽

Case Series ◽

Mortality Data ◽

Serum S100b ◽

Significant Difference ◽

The Mean

BACKGROUND: The pathogenesis of inflammatory neuronal cell damage will continue after traumatic brain injury in which contributed to subsequent mortality. Serum S100B levels were shown to be an early predictor of mortality due to traumatic brain injury. AIM: This Meta-Analysis will analyse the mean and diagnostic strength of serum S100B levels between survived and died subjects with head injuries based on the various follow-up times of nine studies. METHODS: We conducted a meta-anelysis in accordance with PRISMA guidelines and adhering to Cochrane Handbook for Systematic Review of Interventions. Literature search was conducted on March 16, 2018 from Medline and Scopus in the past 10 years, using various keywords related to S100, brain injury, and outcome. Duplicate journals were sorted out via EndNote. Included articles were as follows: original data from the group, clinical trials, case series, patients undergoing serum S100B levels with both short- and long-term follow-up mortality. Data were collected for mortality, serum S100B levels, and its diagnostic strength. All data were analyzed using Review Manager 5.3 (Cochrane, Denmark). RESULTS: The results of the meta-analysis showed a significant difference in S100B levels between survived and died subjects with head injuries on overall follow-up timeline (0.91, 95.9% CI 0.7-1.12, I2 = 98%, p < 0.001), during treatment (1.43, 95% CI 0.97 to 1.89, I2 = 98%, p < 0.001), or 6 months (0.19; 95%CI 0.1-0.29, I2 = 76%, p < 0.001) with an average threshold value that varies according to the study method used. The mean diagnostic strength was also promising to predict early mortality (sensitivity of 77.18% and 92.33%, specificity of 78.35% and 50.6%, respectively). CONCLUSION: S100B serum levels in the future will be potential biomarkers, and it is expected that there will be standardised guidelines for their application.

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Abstract 9115: Determining Optimal Hemoglobin Transfusion Threshold for Patients With Severe Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Circulation ◽

10.1161/circ.144.suppl_2.9115 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Nitish Sood ◽

Arnav Goyal ◽

Dayton Grogan ◽

Vamsi Reddy

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Length Of Stay ◽

Severe Traumatic Brain Injury ◽

Meta Analysis ◽

Cost Of Care ◽

Current Evidence ◽

Transfusion Threshold ◽

Significant Difference

Introduction: Multiple randomized controlled trials have found that a conservative approach to transfusing critically ill patients reduces mortality, with current guidelines recommending a hemoglobin (HgB) transfusion threshold of 7 g/dL. However, little work has examined whether this transfusion threshold reduces mortality in patients with severe traumatic brain injury (TBI). Here, we present a systematic review and meta-analysis of the literature. Methods: A systematic search was conducted on PubMed, Ovid, and Web of Science. Full-text articles were eligible if patients with TBI, defined as Glasgow Coma Score <= 8, were divided into multiple groups with varying hemoglobin transfusion thresholds and reported any outcome of interest including mortality, number of packed red blood cell (PRBC) units transfused, length of stay in ICU, and length of stay in the hospital. Eight studies were eligible (n = 3663). We compared mortality rates at HgB transfusion thresholds of < 7 g/dL, < 8 g/dL, < 9 g/dL, and < 10 g/dL. Results: We found that traditionally ‘conservative’ approaches to anemia management (HgB < 7 g/dL, < 8 g/dL, and < 9 g/dL) were associated with decreased mortality when compared to traditionally ‘liberal’ approaches (HgB < 10 g/dL), with p < 0.05. Results were robust across both frequentist and Bayesian analysis. As a surrogate for cost of care and use of hospital resources, the total number of PRBC units transfused to patients, length of stay in ICU, and length of stay in hospital were analyzed. We found that using a transfusion threshold < 7 g/dL compared to < 10 g/dL substantially decreased the number of PRBC units transfused. In three of five cohorts, the cohort with the lower HgB transfusion threshold or no transfusion had a significantly shorter length of stay in the ICU and in the hospital. The remaining two cohorts found no significant difference in the length of stays in ICU or hospital. Conclusion: This study demonstrates that conservative approaches to transfusions ( < 7 g/dL, < 8 g/dL, or < 9 g/dL) significantly reduce mortality and the number of PRBC units transfused when compared to more liberal approaches ( < 10 g/dL). Current evidence is unclear on the benefits of conservative approaches in reduction of ICU or hospital length of stay.

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Efficacy and safety of erythropoietin for traumatic brain injury

BMC Neurology ◽

10.1186/s12883-020-01958-z ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Motao Liu ◽

Amy J. Wang ◽

Yu Chen ◽

Gexin Zhao ◽

Zhifeng Jiang ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Adverse Effects ◽

Adverse Events ◽

Hospital Mortality ◽

Meta Analysis ◽

Survival Rates ◽

Neurological Function ◽

Cochrane Library

Abstract Background Recent studies regarding the effects of erythropoietin (EPO) for treating traumatic brain injury (TBI) have been inconsistent. This study conducts a meta-analysis of randomized controlled trials (RCTs) to assess the safety and efficacy of EPO for TBI patients at various follow-up time points. Methods A literature search was performed using PubMed, Web of Science, MEDLINE, Embase, Google Scholar and the Cochrane Library for RCTs studying EPO in TBI patients published through March 2019. Non-English manuscripts and non-human studies were excluded. The assessed outcomes include mortality, neurological recovery and associated adverse effects. Dichotomous variables are presented as risk ratios (RR) with a 95% confidence interval (CI). Results A total of seven RCTs involving 1197 TBI patients (611 treated with EPO, 586 treated with placebo) were included in this study. Compared to the placebo arm, treatment with EPO did not improve acute hospital mortality or short-term mortality. However, there was a significant improvement in mid-term (6 months) follow-up survival rates. EPO administration was not associated with neurological function improvement. Regarding adverse effects, EPO treatment did not increase the incidence of thromboembolic events or other associated adverse events. Conclusions This meta-analysis indicates a slight mortality benefit for TBI patients treated with EPO at mid-term follow-up. EPO does not improve in-hospital mortality, nor does it increase adverse events including thrombotic, cardiovascular and other associated complications. Our analysis did not demonstrate a significant beneficial effect of EPO intervention on the recovery of neurological function. Future RCTs are required to further characterize the use of EPO in TBI.

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