The Australian Traumatic Brain Injury Initiative: systematic review of the effect of acute interventions on outcome for people with moderate-severe traumatic brain injury.

BACKGROUND

The Australian Traumatic Brain Injury Initiative (AUS-TBI) is developing a data resource to enable improved outcome prediction for people with moderate-severe TBI (msTBI) across Australia. Fundamental to this resource is the collaboratively designed data dictionary. This systematic review and consultation aimed to identify acute interventions with potential to modify clinical outcomes for people after msTBI, inclusion in a data dictionary.

METHODS

Standardised searches were implemented across bibliographic databases from inception through April 2022. English-language reports of randomised controlled trials (RCTs) evaluating any association between any acute intervention and clinical outcome, in at least 100 patients with msTBI were included. A predefined algorithm was used to assign a value to each observed association. Consultation with AUS-TBI clinicians and researchers formed the consensus process for interventions to be included in a single data dictionary.

FINDINGS

Searches retrieved 14,455 records, of which 124 full-length RCTs were screened, with 35 studies included. These studies evaluated 26 unique acute interventions across 21 unique clinical outcomes. Only four interventions were considered to have medium modifying value for any outcome from the review, with an additional eight interventions agreed upon through the consensus process. The interventions with medium value were tranexamic acid and phenytoin, which had a positive effect on an outcome; and decompressive craniectomy surgery and hypothermia, which negatively affected outcomes.

CONCLUSIONS

From the systematic review and consensus process, 12 interventions were identified as potential modifiers to be included in the AUS-TBI national data resource.