functional outcomes most frequently (21/44)
RESULTS
Primary studies included in SRs
Composition: 403 primary studies, 50957 participants, 335/403 (83.1%) RCTs
In addition to conduction more rigourous clincal trials, metaanalysis of IPD and CER may be a possible direction.
CONTENTS
Introduction Methods Results Discussion Conclusions
CONTENTS
Introduction Methods Results Discussion Conclusions
DISCUSSION
Main findings: not a surprise
As much as 22 therpeutic measures in TBI management shown no efficacy
pharmacological techniques 36/44 of the corresponding authors from high-income countries 29/44 contained meta-analysis vs 15/44 qualitative method 8 primary meansure were analyzed: All-cause mortality and
Cochrane Reviews (n=21) 21/21 21/21 21/21 20/21 18/221 7 (5.5 -7) 19/21
Regular journals reviews (n=23)
23/23 17/23 23/23 18/23 16/23
Only 30% of RCTs conducted is of high quality Cochrane reviews is better than journal reviews
DISCUSSION
The dearth of satisfactory primary evidence to support therapies for acute TBI is widely acknowledged.
The present analysis assessed evidence from systematic reviews in terms of clinical issues, methodological aspects and implication for practice and research.
Cochrane reviews is of better quality than regular journal reviews
OQAQ Item
Search methods used to find evidence stated Search for evidence reasonably comprehensive Criteria used for deciding which studies to include reported Bias in the selection of studies avoided Criteria used for assessing the validity of the included studies reported
DISCUSSION
The fact of uncertainty from SRs and mea RCTs implies many complex factors affecting clinical practice.
There appears a disconnection between basic science and clinical research in TBI.
13/23
20/23 8/23 21/23 4 (2 -7) a 10/23 b
RESULTS
Clinical implication of high-quality SRs
29 high-quality reviews (OQAQ score ≥ 5 ) only one definitive conclusion: Corticosteroids others provide no evidence for routine treatments
Sample size: varied diversly from 4 to 10008, median of 641 (IQR: 233- 1305)
Quality: Among 293 quality-assessed RCTs, 88 reported adequate allocation concealment, i.e. high-quality
Maas and colleges: 33 phase III RCTs, finding no intervention shown convincing benefit in overall population
The largest trials conducted in TBI: CRASH trial, whose design is being questioned
Overall quality (median score/ interquartile range) Minor or minimal flaws (OQAQ score ≥ 5)
All (n=45) 44/44 38/44 44/44 38/44 34/44
33/44
40/44 28/44 42/44 5.5 (2.5 -7) 29/44
Shanghai Institute of Head Trauma
METHODS
Study Selection
Search Results Duplicates excluded Titles and
abstracts screened Full text reviewed
Final
eligibility
CONCLUSIONS
Current evidence seems lack potential of supporting routine therapies in acute TBI management.
Future research in TBI still has a long way to go.
DISCUSSION
Possible Limitations to this study
SRs in other laguages may be missed Interventions may be supported by other forms of high
quality evidence
Evidence from large scale RCTs found no interventions showing effect in TBI management.
High quality systematic reviews(SRs) represent the highest level evidence (Class Ia) for descision making and identfiy the limits of clinical research.
RESULTS
44 eligible SRs identified
(Flow Chart)
RESULTS
General Characteristics
21 Cochrane reviews vs 23 journal reviews Time range: 1997 - 2012, three per year 26 therapeutic measures: 18 pharmacological agents vs 6 non-
Methodological features: method of quality assessment, data synthesis, etc
METHODS
Assessment of Quality
OQAQ checklist: Overview Quality Assessment Questionnaire
Data analysis
Descriptive analysis mainly Comparison of quality between Cochrane reviews and regular journal
reviews
CONTENTS
Introduction Methods Results Discussion Conclusions
Data extraction
General chracteristics: title, publication source, year, first author, country of corresponding author
Clinical issues: foucus intervention, no. of primary studies, no. of RCTs, total pupulation, primay outcomes, conclusion
CONTENTS
Introduction Methods Results Discussion Conclusions