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Low-Value Clinical Practices in Adult Traumatic Brain Injury: An Umbrella Review.
Moore, Lynne; Tardif, Pier-Alexandre; Lauzier, François; Bérubé, Melanie; Archambault, Patrick; Lamontagne, François; Chassé, Michael; Stelfox, Henry T; Gabbe, Belinda; Lecky, Fiona; Kortbeek, John; Lessard Bonaventure, Paule; Truchon, Catherine; Turgeon, Alexis F.
Afiliação
  • Moore L; Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada.
  • Tardif PA; Population Health and Optimal Health Practices Research Unit, Université Laval, Québec City, Québec, Canada.
  • Lauzier F; Population Health and Optimal Health Practices Research Unit, Université Laval, Québec City, Québec, Canada.
  • Bérubé M; Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada.
  • Archambault P; Population Health and Optimal Health Practices Research Unit, Université Laval, Québec City, Québec, Canada.
  • Lamontagne F; Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada.
  • Chassé M; Population Health and Optimal Health Practices Research Unit, Université Laval, Québec City, Québec, Canada.
  • Stelfox HT; Population Health and Optimal Health Practices Research Unit, Université Laval, Québec City, Québec, Canada.
  • Gabbe B; Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada.
  • Lecky F; Department of Medicine, Université de Montréal CRCHUM, Montréal, Québec, Canada.
  • Kortbeek J; Departments of Critical Care Medicine, Medicine, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
  • Lessard Bonaventure P; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
  • Truchon C; Swansea University Medical School, Swansea University, Swansea, United Kingdom.
  • Turgeon AF; School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.
J Neurotrauma ; 37(24): 2605-2615, 2020 12 15.
Article em En | MEDLINE | ID: mdl-32791886
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.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Lesões Encefálicas Traumáticas Tipo de estudo: Prognostic_studies / Systematic_reviews Limite: Adult / Female / Humans / Male Idioma: En Revista: J Neurotrauma Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Lesões Encefálicas Traumáticas Tipo de estudo: Prognostic_studies / Systematic_reviews Limite: Adult / Female / Humans / Male Idioma: En Revista: J Neurotrauma Ano de publicação: 2020 Tipo de documento: Article