Low-Value Clinical Practices in Adult Traumatic Brain Injury: An Umbrella Review

Lynne Moore, Pier Alexandre Tardif, François Lauzier, Melanie Bérubé, Patrick Archambault, François Lamontagne, Michael Chassé, Henry T. Stelfox, Belinda Gabbe, Fiona Lecky, John Kortbeek, Paule Lessard Bonaventure, Catherine Truchon, Alexis F. Turgeon

Research output: Contribution to journalReview ArticleResearchpeer-review

Abstract

Despite numerous interventions and treatment options, the outcomes of traumatic brain injury (TBI) have improved little over the last 3 decades, which raises concern about the value of care in this patient population. We aimed to synthesize the evidence on 14 potentially low-value clinical practices in TBI care. Using umbrella review methodology, we identified systematic reviews evaluating the effectiveness of 14 potentially low-value practices in adults with acute TBI. We present data on methodological quality (Assessing the Methodological Quality of Systematic Reviews), reported effect sizes, and credibility of evidence (I to IV). The only clinical practice with evidence of benefit was therapeutic hypothermia (credibility of evidence II to IV). However, the most recent meta-Analysis on hypothermia based on high-quality trials suggested harm (credibility of evidence IV). Meta-Analyses on platelet transfusion for patients on antiplatelet therapy were all consistent with harm but were statistically non-significant. For the following practices, effect estimates were consistently close to the null: computed tomography (CT) in adults with mild TBI who are low-risk on a validated clinical decision rule; repeat CT in adults with mild TBI on anticoagulant therapy with no clinical deterioration; antibiotic prophylaxis for external ventricular drain placement; and decompressive craniectomy for refractory intracranial hypertension. We identified five clinical practices with evidence of lack of benefit or harm. However, evidence could not be considered to be strong for any clinical practice as effect measures were imprecise and heterogeneous, systematic reviews were often of low quality, and most included studies had a high risk of bias.

Original languageEnglish
Pages (from-to)2605-2615
Number of pages11
JournalJournal of Neurotrauma
Volume37
Issue number24
DOIs
Publication statusPublished - 15 Dec 2020

Keywords

  • low-value clinical practices
  • traumatic brain injury
  • umbrella review

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