naa a22 4500 510799817 CHVBK 20180411083350.0 cr unu---uuuuu 180411e20130201xx s 000 0 eng 10.1007/s12028-012-9748-3 doi (NATIONALLICENCE)springer-10.1007/s12028-012-9748-3 Protocol Management of Severe Traumatic Brain Injury in Intensive Care Units: A Systematic Review [Elektronische Daten] [Shane English, Alexis Turgeon, Elliott Owen, Steve Doucette, Giuseppe Pagliarello, Lauralyn McIntyre] To examine clinical trials and observational studies that compared use of management protocols (MPs) versus usual care for adult intensive care unit (ICU) patients with acute severe traumatic brain injury (TBI) on 6-month neurologic outcome (Glasgow Outcome Scale, GOS) and mortality, major electronic databases were searched from 1950 to April 18, 2011. Abstracts from major international meetings were searched to identify gray literature. A total of 6,151 articles were identified; 488 were reviewed in full and 13 studies were included. Data on patient and MP characteristics, outcomes and methodological quality were extracted. All 13 included studies were observational. A random effects model showed that use of MPs was associated with a favorable neurologic outcome (GOS 4 or 5) at 6months (odds ratio [OR] and 95% confidence interval [CI] 3.84 (2.47-5.96)) but not 12months (OR, 95% CI 0.87 (0.56-1.36)). Use of MPs was associated with reduced mortality at hospital discharge and 6months (OR and 95% CI 0.72 (0.45-1.14) and 0.33 (0.13-0.82) respectively), but not 12months (OR, 95% CI 0.79 (0.5-1.24)). Sources of heterogeneity included variation in study design, methodological quality, MP design, MP neurophysiologic endpoints, and type of ICU. MPs for severe TBI were associated with reductions in death and improved neurologic outcome. Although no definitive conclusions about the efficacy of MPs for severe TBI can be drawn from our study, these results should encourage the conduct of randomized controlled trials to more rigorously examine the efficacy of MPs for severe TBI. Springer Science+Business Media, LLC, 2012 Clinical protocols nationallicence Brain injuries nationallicence Intensive care units nationallicence Critical care nationallicence Evidence-based medicine nationallicence English Shane Department of Medicine (Critical Care), The Ottawa Hospital, Ottawa, ON, Canada aut Turgeon Alexis Department of Anesthesia (Critical Care), L'Enfant-Jésus, Québec City, QC, Canada aut Owen Elliott Department of Medicine (Critical Care), The Ottawa Hospital, Ottawa, ON, Canada aut Doucette Steve Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada aut Pagliarello Giuseppe Department of Surgery (Critical Care), The Ottawa Hospital, Ottawa, ON, Canada aut McIntyre Lauralyn Department of Medicine (Critical Care), The Ottawa Hospital, The Ottawa Hospital Research Institute, Ottawa, ON, Canada aut Neurocritical Care Humana Press Inc 18/1(2013-02-01), 131-142 1541-6933 18:1<131 2013 18 12028 https://doi.org/10.1007/s12028-012-9748-3 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-012-9748-3 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- English Shane Department of Medicine (Critical Care), The Ottawa Hospital, Ottawa, ON, Canada aut NATIONALLICENCE 700 1- Turgeon Alexis Department of Anesthesia (Critical Care), L'Enfant-Jésus, Québec City, QC, Canada aut NATIONALLICENCE 700 1- Owen Elliott Department of Medicine (Critical Care), The Ottawa Hospital, Ottawa, ON, Canada aut NATIONALLICENCE 700 1- Doucette Steve Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada aut NATIONALLICENCE 700 1- Pagliarello Giuseppe Department of Surgery (Critical Care), The Ottawa Hospital, Ottawa, ON, Canada aut NATIONALLICENCE 700 1- McIntyre Lauralyn Department of Medicine (Critical Care), The Ottawa Hospital, The Ottawa Hospital Research Institute, Ottawa, ON, Canada aut NATIONALLICENCE 773 0- Neurocritical Care Humana Press Inc 18/1(2013-02-01), 131-142 1541-6933 18:1<131 2013 18 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer