The currency, completeness and quality of systematic reviews of acute management of moderate to severe traumatic brain injury: A comprehensive evidence map

Anneliese Synnot, Peter Bragge, Carole Lunny, David Menon, Ornella Clavisi, Loyal Pattuwage, Victor Volovici, Stefania Mondello, Maryse C. Cnossen, Emma Donoghue, Russell L. Gruen, Andrew Maas

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective To appraise the currency, completeness and quality of evidence from systematic reviews (SRs) of acute management of moderate to severe traumatic brain injury (TBI). Methods We conducted comprehensive searches to March 2016 for published, English-language SRs and RCTs of acute management of moderate to severe TBI. Systematic reviews and RCTs were grouped under 12 broad intervention categories. For each review, we mapped the included and non-included RCTs, noting the reasons why RCTs were omitted. An SR was judged as ‘current’ when it included the most recently published RCT we found on their topic, and ‘complete’ when it included every RCT we found that met its inclusion criteria, taking account of when the review was conducted. Quality was assessed using the AMSTAR checklist (trichotomised into low, moderate and high quality). Findings We included 85 SRs and 213 RCTs examining the effectiveness of treatments for acute management of moderate to severe TBI. The most frequently reviewed interventions were hypothermia (n = 17, 14.2%), hypertonic saline and/or mannitol (n = 9, 7.5%) and surgery (n = 8, 6.7%). Of the 80 single-intervention SRs, approximately half (n = 44, 55%) were judged as current and two-thirds (n = 52, 65.0%) as complete. When considering only the most recently published review on each intervention (n = 25), currency increased to 72.0% (n = 18). Less than half of the 85 SRs were judged as high quality (n = 38, 44.7%), and nearly 20% were low quality (n = 16, 18.8%). Only 16 (20.0%) of the single-intervention reviews (and none of the five multi-intervention reviews) were judged as current, complete and high-quality. These included reviews of red blood cell transfusion, hypothermia, management guided by intracranial pressure, pharmacological agents (various) and prehospital intubation. Over three-quarters (n = 167, 78.4%) of the 213 RCTs were included in one or more SR. Of the remainder, 17 (8.0%) RCTs post-dated or were out of scope of existing SRs, and 29 (13.6%) were on interventions that have not been assessed in SRs. Conclusion A substantial number of SRs in acute management of moderate to severe TBI lack currency, completeness and quality. We have identified both potential evidence gaps and also substantial research waste. Novel review methods, such as Living Systematic Reviews, may ameliorate these shortcomings and enhance utility and reliability of the evidence underpinning clinical care.

Original languageEnglish
Article numbere0198676
Number of pages25
JournalPLoS ONE
Volume13
Issue number6
DOIs
Publication statusPublished - 1 Jun 2018

Cite this

Synnot, Anneliese ; Bragge, Peter ; Lunny, Carole ; Menon, David ; Clavisi, Ornella ; Pattuwage, Loyal ; Volovici, Victor ; Mondello, Stefania ; Cnossen, Maryse C. ; Donoghue, Emma ; Gruen, Russell L. ; Maas, Andrew. / The currency, completeness and quality of systematic reviews of acute management of moderate to severe traumatic brain injury : A comprehensive evidence map. In: PLoS ONE. 2018 ; Vol. 13, No. 6.
@article{3fa902bafd764c929b566584a594b28e,
title = "The currency, completeness and quality of systematic reviews of acute management of moderate to severe traumatic brain injury: A comprehensive evidence map",
abstract = "Objective To appraise the currency, completeness and quality of evidence from systematic reviews (SRs) of acute management of moderate to severe traumatic brain injury (TBI). Methods We conducted comprehensive searches to March 2016 for published, English-language SRs and RCTs of acute management of moderate to severe TBI. Systematic reviews and RCTs were grouped under 12 broad intervention categories. For each review, we mapped the included and non-included RCTs, noting the reasons why RCTs were omitted. An SR was judged as ‘current’ when it included the most recently published RCT we found on their topic, and ‘complete’ when it included every RCT we found that met its inclusion criteria, taking account of when the review was conducted. Quality was assessed using the AMSTAR checklist (trichotomised into low, moderate and high quality). Findings We included 85 SRs and 213 RCTs examining the effectiveness of treatments for acute management of moderate to severe TBI. The most frequently reviewed interventions were hypothermia (n = 17, 14.2{\%}), hypertonic saline and/or mannitol (n = 9, 7.5{\%}) and surgery (n = 8, 6.7{\%}). Of the 80 single-intervention SRs, approximately half (n = 44, 55{\%}) were judged as current and two-thirds (n = 52, 65.0{\%}) as complete. When considering only the most recently published review on each intervention (n = 25), currency increased to 72.0{\%} (n = 18). Less than half of the 85 SRs were judged as high quality (n = 38, 44.7{\%}), and nearly 20{\%} were low quality (n = 16, 18.8{\%}). Only 16 (20.0{\%}) of the single-intervention reviews (and none of the five multi-intervention reviews) were judged as current, complete and high-quality. These included reviews of red blood cell transfusion, hypothermia, management guided by intracranial pressure, pharmacological agents (various) and prehospital intubation. Over three-quarters (n = 167, 78.4{\%}) of the 213 RCTs were included in one or more SR. Of the remainder, 17 (8.0{\%}) RCTs post-dated or were out of scope of existing SRs, and 29 (13.6{\%}) were on interventions that have not been assessed in SRs. Conclusion A substantial number of SRs in acute management of moderate to severe TBI lack currency, completeness and quality. We have identified both potential evidence gaps and also substantial research waste. Novel review methods, such as Living Systematic Reviews, may ameliorate these shortcomings and enhance utility and reliability of the evidence underpinning clinical care.",
author = "Anneliese Synnot and Peter Bragge and Carole Lunny and David Menon and Ornella Clavisi and Loyal Pattuwage and Victor Volovici and Stefania Mondello and Cnossen, {Maryse C.} and Emma Donoghue and Gruen, {Russell L.} and Andrew Maas",
year = "2018",
month = "6",
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doi = "10.1371/journal.pone.0198676",
language = "English",
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The currency, completeness and quality of systematic reviews of acute management of moderate to severe traumatic brain injury : A comprehensive evidence map. / Synnot, Anneliese; Bragge, Peter; Lunny, Carole; Menon, David; Clavisi, Ornella; Pattuwage, Loyal; Volovici, Victor; Mondello, Stefania; Cnossen, Maryse C.; Donoghue, Emma; Gruen, Russell L.; Maas, Andrew.

In: PLoS ONE, Vol. 13, No. 6, e0198676, 01.06.2018.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - The currency, completeness and quality of systematic reviews of acute management of moderate to severe traumatic brain injury

T2 - A comprehensive evidence map

AU - Synnot, Anneliese

AU - Bragge, Peter

AU - Lunny, Carole

AU - Menon, David

AU - Clavisi, Ornella

AU - Pattuwage, Loyal

AU - Volovici, Victor

AU - Mondello, Stefania

AU - Cnossen, Maryse C.

AU - Donoghue, Emma

AU - Gruen, Russell L.

AU - Maas, Andrew

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Objective To appraise the currency, completeness and quality of evidence from systematic reviews (SRs) of acute management of moderate to severe traumatic brain injury (TBI). Methods We conducted comprehensive searches to March 2016 for published, English-language SRs and RCTs of acute management of moderate to severe TBI. Systematic reviews and RCTs were grouped under 12 broad intervention categories. For each review, we mapped the included and non-included RCTs, noting the reasons why RCTs were omitted. An SR was judged as ‘current’ when it included the most recently published RCT we found on their topic, and ‘complete’ when it included every RCT we found that met its inclusion criteria, taking account of when the review was conducted. Quality was assessed using the AMSTAR checklist (trichotomised into low, moderate and high quality). Findings We included 85 SRs and 213 RCTs examining the effectiveness of treatments for acute management of moderate to severe TBI. The most frequently reviewed interventions were hypothermia (n = 17, 14.2%), hypertonic saline and/or mannitol (n = 9, 7.5%) and surgery (n = 8, 6.7%). Of the 80 single-intervention SRs, approximately half (n = 44, 55%) were judged as current and two-thirds (n = 52, 65.0%) as complete. When considering only the most recently published review on each intervention (n = 25), currency increased to 72.0% (n = 18). Less than half of the 85 SRs were judged as high quality (n = 38, 44.7%), and nearly 20% were low quality (n = 16, 18.8%). Only 16 (20.0%) of the single-intervention reviews (and none of the five multi-intervention reviews) were judged as current, complete and high-quality. These included reviews of red blood cell transfusion, hypothermia, management guided by intracranial pressure, pharmacological agents (various) and prehospital intubation. Over three-quarters (n = 167, 78.4%) of the 213 RCTs were included in one or more SR. Of the remainder, 17 (8.0%) RCTs post-dated or were out of scope of existing SRs, and 29 (13.6%) were on interventions that have not been assessed in SRs. Conclusion A substantial number of SRs in acute management of moderate to severe TBI lack currency, completeness and quality. We have identified both potential evidence gaps and also substantial research waste. Novel review methods, such as Living Systematic Reviews, may ameliorate these shortcomings and enhance utility and reliability of the evidence underpinning clinical care.

AB - Objective To appraise the currency, completeness and quality of evidence from systematic reviews (SRs) of acute management of moderate to severe traumatic brain injury (TBI). Methods We conducted comprehensive searches to March 2016 for published, English-language SRs and RCTs of acute management of moderate to severe TBI. Systematic reviews and RCTs were grouped under 12 broad intervention categories. For each review, we mapped the included and non-included RCTs, noting the reasons why RCTs were omitted. An SR was judged as ‘current’ when it included the most recently published RCT we found on their topic, and ‘complete’ when it included every RCT we found that met its inclusion criteria, taking account of when the review was conducted. Quality was assessed using the AMSTAR checklist (trichotomised into low, moderate and high quality). Findings We included 85 SRs and 213 RCTs examining the effectiveness of treatments for acute management of moderate to severe TBI. The most frequently reviewed interventions were hypothermia (n = 17, 14.2%), hypertonic saline and/or mannitol (n = 9, 7.5%) and surgery (n = 8, 6.7%). Of the 80 single-intervention SRs, approximately half (n = 44, 55%) were judged as current and two-thirds (n = 52, 65.0%) as complete. When considering only the most recently published review on each intervention (n = 25), currency increased to 72.0% (n = 18). Less than half of the 85 SRs were judged as high quality (n = 38, 44.7%), and nearly 20% were low quality (n = 16, 18.8%). Only 16 (20.0%) of the single-intervention reviews (and none of the five multi-intervention reviews) were judged as current, complete and high-quality. These included reviews of red blood cell transfusion, hypothermia, management guided by intracranial pressure, pharmacological agents (various) and prehospital intubation. Over three-quarters (n = 167, 78.4%) of the 213 RCTs were included in one or more SR. Of the remainder, 17 (8.0%) RCTs post-dated or were out of scope of existing SRs, and 29 (13.6%) were on interventions that have not been assessed in SRs. Conclusion A substantial number of SRs in acute management of moderate to severe TBI lack currency, completeness and quality. We have identified both potential evidence gaps and also substantial research waste. Novel review methods, such as Living Systematic Reviews, may ameliorate these shortcomings and enhance utility and reliability of the evidence underpinning clinical care.

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