Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G2A2, Canada.
Department of Medical Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4 L8, Canada.
Syst Rev. 2020 Feb 3;9(1):23. doi: 10.1186/s13643-020-1281-4.
Traumatic brain injury (TBI) is a leading cause of death and disability. Recently, a paradigm shift in our understanding of moderate-to-severe TBI has led to its reconceptualization as a progressive neurodegenerative disorder. Widespread progressive atrophy is observed in the months and years post-injury, long after the acute effects of the injury have resolved. Some studies have begun to examine prognostic demographic, injury-related, and post-injury risk factors that contribute to these declines. A synthesis of this information, and in particular, an increased understanding of post-injury factors that may be modifiable, would improve our ability to design interventions to reduce neurodegeneration in moderate-to-severe TBI. This systematic review aims to identify prognostic factors for neural deterioration in moderate-to-severe TBI, and thereby inform future intervention research in this population.
This review protocol was informed by and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) guidelines. Search strategies (designed to identify literature on prognostic factors of neurodegeneration in adults with moderate-to-severe TBI) optimized for MEDLINE, EMBASE PsychINFO, CINAHL, SportDiscus, and Cochrane Central Register of Controlled Trials will be developed with the assistance of a health sciences librarian. Retrieved studies will be screened by two team members. Studies must report on longitudinal neuroimaging (i.e., two or more scans in the same cohort) or neuroimaging in a cross-sectional study and potential prognostic factors for neurodegeneration, such as demographics (e.g., gender, age, education), injury (e.g., severity, etiology), or post-injury characteristics (e.g., type and length of therapy, activity level, mood).
By identifying prognostic factors for neurodegeneration, this systematic review can help inform injury management, as well as intervention research designed to offset the effects of modifiable prognostic factors, such as low levels of cognitive or physical activity. In turn, this systematic review can increase our understanding of how to improve outcome following moderate-to-severe TBI.
PROSPERO CRD42019122389.
创伤性脑损伤（TBI）是导致死亡和残疾的主要原因。最近，我们对中度至重度 TBI 的理解发生了范式转变，将其重新概念化为进行性神经退行性疾病。受伤后数月和数年内会观察到广泛的进行性萎缩，远远超出了损伤的急性影响期。一些研究开始研究导致这些下降的预后人口统计学、损伤相关和损伤后风险因素。综合这些信息，特别是增加对可能可改变的损伤后因素的理解，将提高我们设计干预措施以减少中度至重度 TBI 中神经退行性变的能力。本系统评价旨在确定中度至重度 TBI 中神经恶化的预后因素，从而为该人群的未来干预研究提供信息。
本综述方案由并按照系统评价和荟萃分析首选报告项目（PRISMA-P）指南制定和实施。将在健康科学图书馆员的协助下，制定针对 MEDLINE、EMBASE PsychINFO、CINAHL、SportDiscus 和 Cochrane 对照试验中心注册库的搜索策略（旨在确定成年人中度至重度 TBI 中神经退行性病变的预后因素的文献）。将由两名团队成员筛选检索到的研究。研究必须报告纵向神经影像学（即同一队列中的两次或多次扫描）或横断面研究中的神经影像学，以及神经退行性变的潜在预后因素，例如人口统计学因素（例如，性别、年龄、教育程度）、损伤（例如，严重程度、病因）或损伤后特征（例如，治疗类型和长度、活动水平、情绪）。
通过确定神经退行性变的预后因素，本系统评价可以帮助为损伤管理提供信息，并为旨在抵消可改变预后因素（例如认知或体力活动水平低）影响的干预研究提供信息。反过来，本系统评价可以提高我们对如何改善中度至重度 TBI 预后的理解。
PROSPERO CRD42019122389。
