Division of Geriatric Medicine, Department of Medicine, University of Toronto, 190 Elizabeth Street, R. Fraser Elliott Building, 3-805, Toronto, ON, M5G 2C4, Canada.
Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, East Building, Toronto, ON, M5B 1W8, Canada.
J Neurol. 2023 Dec;270(12):5966-5987. doi: 10.1007/s00415-023-11889-7. Epub 2023 Aug 27.
Our systematic review examines the effectiveness and safety of non-pharmacologic and pharmacologic interventions in preventing or treating traumatic brain injury (TBI)-related delirium in acute care.
We searched four electronic databases (MEDLINE, EMBASE, CENTRAL/CDSR, and PsycINFO) to identify randomized controlled trials (RCTs), quasi-experimental, and observational studies. Eligible studies included adults with TBI, at least one comparator group, delirium as an outcome and took place in acute care. Two reviewers independently completed all study screening, data abstraction, and risk of bias assessment using the Cochrane risk of bias 2 tool for RCTs or risk of bias in non-randomized studies-of interventions tool for observational studies. We implemented the PROGRESS-Plus framework to describe social determinants of health (SDoH) reporting.
We identified 20,022 citations, reviewed 301 in full text, and included eight studies in the descriptive synthesis. The mean age of study participants ranged from 32 to 62 years. 12.5% of included studies reported SDoH. Included studies had moderate-to-high risk of bias. Studies compared reorientation programs and an intervention bundle to usual care, but these interventions were not better than usual care in treating TBI-related delirium. Individual studies found that rosuvastatin and aripiprazole were more efficacious than placebo, and dexmedetomidine was more efficacious than propofol and haloperidol for preventing TBI-related delirium. No studies reported safety as the primary outcome.
We identified efficacious pharmacologic interventions for preventing TBI-related delirium, but these studies were at moderate-to-high risk of bias, which limits our confidence in these findings. Future studies should incorporate safety outcomes, and a diverse study population, including older adults.
本系统评价考察了非药物和药物干预措施在预防或治疗急性护理中创伤性脑损伤（TBI）相关谵妄的有效性和安全性。
我们检索了四个电子数据库（MEDLINE、EMBASE、CENTRAL/CDSR 和 PsycINFO），以确定随机对照试验（RCT）、准实验和观察性研究。合格的研究包括 TBI 成人患者，至少有一个对照组，以谵妄为结局，并在急性护理中进行。两位评审员独立完成了所有研究筛选、数据提取和偏倚风险评估，使用 Cochrane 偏倚风险 2 工具评估 RCT，或使用非随机干预研究偏倚风险工具评估观察性研究。我们实施了 PROGRESS-Plus 框架来描述健康的社会决定因素（SDoH）报告。
我们共确定了 20022 条引文，对 301 篇全文进行了审查，并纳入了 8 项描述性综合研究。研究参与者的平均年龄从 32 岁到 62 岁不等。纳入的研究中有 12.5%报告了 SDoH。纳入的研究存在中等到高度的偏倚风险。研究比较了定向程序和干预包与常规护理，但这些干预措施在治疗 TBI 相关谵妄方面并不优于常规护理。个别研究发现，瑞舒伐他汀和阿立哌唑比安慰剂更有效，右美托咪定比丙泊酚和氟哌啶醇更有效预防 TBI 相关谵妄。没有研究报告安全性作为主要结局。
我们确定了有效的药物干预措施来预防 TBI 相关谵妄，但这些研究存在中等到高度的偏倚风险，这限制了我们对这些发现的信心。未来的研究应纳入安全性结果，并纳入包括老年人在内的不同研究人群。
