Department of Rehabilitation, Royal Melbourne Hospital, Parkville, Victoria, Australia.
Australian Rehabilitation Research Centre, Royal Melbourne Hospital, Parkville, Victoria, Australia.
PLoS One. 2022 Sep 1;17(9):e0273998. doi: 10.1371/journal.pone.0273998. eCollection 2022.
Many clinical interventions are trialled to manage medical complications following Traumatic Brain Injury (TBI). However, published evidence for the effects of those clinical interventions is limited. This article is an overview of common complications and their management from published systematic reviews in TBI.
A health science electronic database search for published systematic reviews for management of common complications in TBI was conducted in the last decade till 31st January 2021. Methodological quality and evidence were critically appraised using the Grading of Recommendations, Assessment, Development and Evaluations and Revised-Assessment of Multiple Systematic review tools. Overall, only six systematic reviews complied with search criteria, these evaluated fatigue, spasticity and post traumatic seizures (29 RCTs, 13 cohort studies, n = 5639 participants). No systematic reviews for other common TBI-related complications met criteria for this review. The included reviews varied from 'moderate to high' in methodological quality. The findings suggest beneficial treatment effect of anti-epileptic drugs (phenytoin/levetiracetam) compared with placebo in reducing early seizure incidence, but no significant benefit of phenytoin over levetiracetam, valproate, or neuroprotective agent for early or late posttraumatic seizures. There was 'limited' evidence for spasticity-related interventions, and 'insufficient' evidence of cardiorespiratory training on fatigue levels.
Despite the high prevalence and associated functional impact of TBI-related complications, there is limited evidence to guide treating clinicians for management of common TBI complications. More robust studies are needed to build evidence in this population.
许多临床干预措施都经过试验以处理创伤性脑损伤 (TBI) 后的医疗并发症。然而，发表的关于这些临床干预措施效果的证据有限。本文概述了 TBI 中常见并发症及其管理的研究。
在过去十年中，我们对 TBI 常见并发症管理的已发表系统评价进行了健康科学电子数据库搜索，截止日期为 2021 年 1 月 31 日。使用推荐评估、制定与评估分级和修订后的系统评价多中心评估工具对方法学质量和证据进行了批判性评估。总体而言，只有六项系统评价符合搜索标准，这些评价评估了疲劳、痉挛和创伤后癫痫（29 项 RCT、13 项队列研究，n = 5639 名参与者）。没有其他常见 TBI 相关并发症的系统评价符合本综述的标准。纳入的评价在方法学质量方面从“中度”到“高度”不等。研究结果表明，与安慰剂相比，抗癫痫药物（苯妥英/左乙拉西坦）在降低早期癫痫发作发生率方面具有有益的治疗效果，但苯妥英与左乙拉西坦、丙戊酸钠或神经保护剂相比，对早期或晚期创伤后癫痫发作没有显著益处。痉挛相关干预措施的证据“有限”，疲劳水平的心肺训练证据“不足”。
尽管 TBI 相关并发症的患病率高且相关功能影响大，但目前指导治疗临床医生处理常见 TBI 并发症的证据有限。需要更有力的研究来为这一人群建立证据。
