An Overview of Randomized Controlled Trials Examining Prescription and Nonprescription Pharmacological Interventions for Moderate to Severe Traumatic Brain Injury.

Autor:	Mehrabi S; Lawson Research Institute, St. Joseph's Health Care London, London, ON, Canada., Flores-Sandoval C; Lawson Research Institute, St. Joseph's Health Care London, London, ON, Canada., Teasell R; Lawson Research Institute, St. Joseph's Health Care London, London, ON, Canada.; Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada., MacKenzie HM; Lawson Research Institute, St. Joseph's Health Care London, London, ON, Canada.; Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada., Kurian M; Lawson Research Institute, St. Joseph's Health Care London, London, ON, Canada., Bateman EA; Lawson Research Institute, St. Joseph's Health Care London, London, ON, Canada.; Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Jazyk:	angličtina
Zdroj:	The Journal of pharmacy technology : jPT : official publication of the Association of Pharmacy Technicians [J Pharm Technol] 2024 Nov 16, pp. 87551225241296420. Date of Electronic Publication: 2024 Nov 16.
DOI:	10.1177/87551225241296420
Abstrakt:	Objective: To characterize randomized controlled trials (RCTs) of pharmacological interventions (prescription medications, nonprescription medications, and supplements) for the management of moderate to severe traumatic brain injury (MSTBI). Data sources: Systematic searches were conducted in MEDLINE, PubMed, Scopus, CINAHL, EMBASE, and PsycINFO for RCTs up to December 2022 inclusive in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study selection and data extraction: Inclusion criteria were RCT study design; participants' mean age ≥ 18 years and ≥ 50% had MSTBI; examined ≥ 1 pharmacological intervention(s), either alone or in combination with other interventions. Two independent reviewers conducted Cochrane risk of bias assessment. Data synthesis: Three hundred thirteen RCTs (1978-2022) met inclusion criteria. A total of 146 unique pharmacotherapies and supplements were studied. The most frequently studied intervention was mannitol ( n = 20 RCTs). Mean sample size was 230.4 (4-12 737) and 195 studies (62.3%) were conducted in the acute phase post-MSTBI. Four hundred thirty-five unique outcome measures (OMs) were studied; the most common OMs used were Glasgow Outcome Scale (GOS) (29.4%), mortality (25.2%), and intracranial pressure (25.2%), Glasgow Coma Scale (GCS) (19.5%), and mean arterial pressure (17.3%), and heart rate (10%). Of the included studies, only 7% ( n = 22) had low risk of bias. Conclusion: The paucity of high-quality studies, variability in RCT methodology, sample sizes, and OMs utilization, as well as the low number of RCTs conducted in the subacute- and chronic-phase after injury pose a challenge for conducting meta-analyses to provide strong recommendations for informed decision-making in clinical practice. Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: R Teasell had received a grant from Allergan, now Abbvie (makers of Botox) for Stroke research within the last 3 years. The authors report there are no competing interests to declare. (© The Author(s) 2024.)
Databáze:	MEDLINE
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