The efficacy of erythropoietin in treating experimental traumatic brain injury: a systematic review of controlled trials in animal models

Object Erythropoietin (EPO) shows promise as a neuroprotective agent in animal models of traumatic brain injury (TBI). However, clinical trials of the efficacy of EPO treatment in patients with TBI yield conflicting results. The authors conducted a systematic review and meta-analysis to assess the effect of EPO in experimental animal models of TBI, the goal being to inform the design of future clinical trials. Methods The authors identified eligible studies by searching PubMed, Web of Science, MEDLINE, Embase, and Google Scholar in October 2013. Data were pooled using the random-effects model, and results were reported in terms of standardized mean difference. Statistical heterogeneity was examined using both I2 and chi-square tests, and the presence of small study effects was investigated with funnel plots and Egger tests. In-depth analyses were performed for lesion volume and neurobehavioral outcome, and the studies' methodological quality was also evaluated. Results Of a total of 290 studies, 13 found an effect of EPO on lesion volume and neurobehavioral outcome. Overall, the methodological quality of the studies was poor, and there was evidence of statistical heterogeneity among the publications as well as small-study effects. However, in-depth analyses showed statistically significant findings in favor of a beneficial effect of EPO after TBI. Conclusions Despite limitations of this systematic review that may have influenced the findings, the authors conclude that EPO might be beneficial in treating experimental TBI in terms of reducing lesion volume and improving neurobehavioral outcome. However, this review also indicates that more well-designed and well-reported animal studies are needed.

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Intraoperative hypothermia during vascular neurosurgical procedures

Neurosurgical FOCUS ◽

10.3171/2009.3.focus0927 ◽

2009 ◽

Vol 26 (5) ◽

pp. E24 ◽

Cited By ~ 11

Author(s):

Raymond Choi ◽

Robert H. Andres ◽

Gary K. Steinberg ◽

Raphael Guzman

Keyword(s):

Traumatic Brain Injury ◽

Clinical Trials ◽

Brain Injury ◽

Animal Models ◽

Mild Hypothermia ◽

Scientific Evidence ◽

Neurosurgical Procedures ◽

Ischemic Damage ◽

Intraoperative Hypothermia ◽

Improved Outcomes

Increasing evidence in animal models and clinical trials for stroke, hypoxic encephalopathy for children, and traumatic brain injury have shown that mild hypothermia may attenuate ischemic damage and improve neurological outcome. However, it is less clear if mild intraoperative hypothermia during vascular neurosurgical procedures results in improved outcomes for patients. This review examines the scientific evidence behind hypothermia as a treatment and discusses factors that may be important for the use of this adjuvant technique, including cooling temperature, duration of hypothermia, and rate of rewarming.

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A systematic review of large animal models of combined traumatic brain injury and hemorrhagic shock

Neuroscience & Biobehavioral Reviews ◽

10.1016/j.neubiorev.2019.06.024 ◽

2019 ◽

Vol 104 ◽

pp. 160-177 ◽

Cited By ~ 2

Author(s):

Andrew R. Mayer ◽

Andrew B. Dodd ◽

Meghan S. Vermillion ◽

David D. Stephenson ◽

Irshad H. Chaudry ◽

...

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Animal Models ◽

Hemorrhagic Shock ◽

Large Animal ◽

Large Animal Models

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Effects of Pediatric Traumatic Brain Injury on Verbal IQ: A Systematic Review and Meta-Analysis

Journal of the International Neuropsychological Society ◽

10.1017/s1355617721001296 ◽

2021 ◽

pp. 1-13

Author(s):

Carly A. Cermak ◽

Shannon E. Scratch ◽

Nick P. Reed ◽

Lisa Kakonge ◽

Deryk S. Beal

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Meta Analysis ◽

Small Sample ◽

Extensive Literature ◽

Pediatric Traumatic Brain Injury ◽

Mild Tbi ◽

Verbal Iq ◽

Statistical Heterogeneity

Abstract Objectives: To examine the effects of pediatric traumatic brain injury (TBI) on verbal IQ by severity and over time. Methods: A systematic review and subsequent meta-analysis of verbal IQ by TBI severity were conducted using a random effects model. Subgroup analysis included two epochs of time (e.g., <12 months postinjury and ≥12 months postinjury). Results: Nineteen articles met inclusion criteria after an extensive literature search in MEDLINE, PsycInfo, Embase, and CINAHL. Meta-analysis revealed negative effects of injury across severities for verbal IQ and at both time epochs except for mild TBI < 12 months postinjury. Statistical heterogeneity (i.e., between-study variability) stemmed from studies with inconsistent classification of mild TBI, small sample sizes, and in studies of mixed TBI severities, although not significant. Risk of bias on estimated effects was generally low (k = 15) except for studies with confounding bias (e.g., lack of group matching by socio-demographics; k = 2) and measurement bias (e.g., outdated measure at time of original study, translated measure; k = 2). Conclusions: Children with TBI demonstrate long-term impairment in verbal IQ, regardless of severity. Future studies are encouraged to include scores from subtests within verbal IQ (e.g., vocabulary, similarities, comprehension) in addition to functional language measures (e.g., narrative discourse, reading comprehension, verbal reasoning) to elucidate higher-level language difficulties experienced in this population.

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Beta-2 Receptor Antagonists for Traumatic Brain Injury: A Systematic Review of Controlled Trials in Animal Models

CNS Neuroscience & Therapeutics ◽

10.1111/j.1755-5949.2008.00069.x ◽

2009 ◽

Vol 15 (1) ◽

pp. 52-64 ◽

Cited By ~ 15

Author(s):

K. Ker ◽

P. Perel ◽

K. Blackhall

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Animal Models ◽

Controlled Trials ◽

Receptor Antagonists ◽

Beta 2

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Telerehabilitation Versus Standard Care for Improving Cognitive Function and Quality of Life for Adults with Traumatic Brain Injury: a Systematic Review

Internet Journal of Allied Health Sciences and Practice ◽

10.46743/1540-580x/2018.1753 ◽

2018 ◽

Author(s):

Samantha Betts ◽

Lana Feichter ◽

Zoe Kleinig ◽

Alice O'Connell-Debais ◽

Henry Thai ◽

...

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Methodological Quality ◽

Randomised Controlled Trials ◽

Critical Appraisal ◽

Current Evidence ◽

Cochrane Library ◽

Controlled Trials ◽

Randomised Controlled

ABSTRACT Traumatic brain injury (TBI) is the most significant cause of death and severe disability following major trauma within Australia. Populations at risk include young adults aged 15 to 34, older adults, and military personnel. The main form of intervention following traumatic brain injury is rehabilitation, which places a large demand on the healthcare system. Telerehabilitation involves interventions delivered via telecommunication, which can improve accessibility and reduce this burden. There have been no systematic reviews conducted on the effectiveness of telerehabilitation in treating traumatic brain injury. Purpose: To examine the effectiveness of telerehabilitation for adults with traumatic brain injury. Methods: A systematic search of Medline, Embase, the Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, The Cochrane Library, OTSeeker and Google Scholar was conducted. Studies were included with participants aged 18 to 64 with traumatic brain injury and receiving telerehabilitation interventions. Methodological quality was assessed using the critical appraisal tools: Critical Appraisal Skills Programme (CASP) checklist for randomised controlled trials, and McMaster Critical Review for Quantitative Studies for non-randomised studies. Results: Three randomised controlled trials, one pseudo-randomised controlled trial, one case-control trial and one pre-post case series were included in this systematic review. Critical appraisal of the included studies revealed overall methodological quality to be moderate. A range of interventions with differing parameters were used as part of telerehabilitation. Collectively, there is some consistent evidence to indicate that telerehabilitation may be equally effective as other forms of care in the delivery of cognitive and psychological interventions, in addressing memory and depressive symptoms for adults with mild to severe traumatic brain injury. However, it is unclear if it is superior to other forms of care. Conclusions: A small number of studies have investigated the effect of telerehabilitation for adults with traumatic brain injury. The current evidence base is limited due to lack of standardised intervention parameters, outcomes measures and robust sample size. Despite these limitations, telerehabilitation may offer a complementary model of care for adults with traumatic brain injury, especially in instances where traditional models of care may not be readily accessible (such as those in rural and remote areas).

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Incidence and impact of withdrawal of life-sustaining therapies in clinical trials of severe traumatic brain injury: A systematic review

Clinical Trials ◽

10.1177/1740774518771233 ◽

2018 ◽

Vol 15 (4) ◽

pp. 398-412 ◽

Cited By ~ 4

Author(s):

Guillaume Leblanc ◽

Amélie Boutin ◽

Michèle Shemilt ◽

François Lauzier ◽

Lynne Moore ◽

...

Keyword(s):

Systematic Review ◽

Traumatic Brain Injury ◽

Clinical Trials ◽

Brain Injury ◽

Randomized Controlled Trials ◽

Severe Traumatic Brain Injury ◽

Controlled Trials ◽

Randomized Controlled ◽

The Impact ◽

Overall Mortality

Background Most deaths following severe traumatic brain injury follow decisions to withdraw life-sustaining therapies. However, the incidence of the withdrawal of life-sustaining therapies and its potential impact on research data interpretation have been poorly characterized. The aim of this systematic review was to assess the reporting and the impact of withdrawal of life-sustaining therapies in randomized clinical trials of patients with severe traumatic brain injury. Methods We searched Medline, Embase, Cochrane Central, BIOSIS, and CINAHL databases and references of included trials. All randomized controlled trials published between January 2002 and August 2015 in the six highest impact journals in general medicine, critical care medicine, and neurocritical care (total of 18 journals) were considered for eligibility. Randomized controlled trials were included if they enrolled adult patients with severe traumatic brain injury (Glasgow Coma Scale ≤ 8) and reported data on mortality. Our primary objective was to assess the proportion of trials reporting the withdrawal of life-sustaining therapies in a publication. Our secondary objectives were to describe the overall mortality rate, the proportion of deaths following the withdrawal of life-sustaining therapies, and to assess the impact of the withdrawal of life-sustaining therapies on trial results. Results From 5987 citations retrieved, we included 41 randomized trials (n = 16,364, ranging from 11 to 10,008 patients). Overall mortality was 23% (range = 3%–57%). Withdrawal of life-sustaining therapies was reported in 20% of trials (8/41, 932 patients in trials) and the crude number of deaths due to the withdrawal of life-sustaining therapies was reported in 17% of trials (7/41, 884 patients in trials). In these trials, 63% of deaths were associated with the withdrawal of life-sustaining therapies (105/168). An analysis carried out by imputing a 4% differential rate in instances of withdrawal of life-sustaining therapies between study groups yielded different results and conclusions in one third of the trials. Conclusion Data on the withdrawal of life-sustaining therapies are incompletely reported in randomized controlled trials of patients with severe traumatic brain injury. Given the high proportion of deaths due to the withdrawal of life-sustaining therapies in severe traumatic brain injury patients, and the potential of this medical decision to influence the results of clinical trials, instances of withdrawal of life-sustaining therapies should be systematically reported in clinical trials in this group of patients.

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