title: Pharmacological interventions in traumatic brain injury: Can we rely on systematic reviews for evidence?
abstract: BACKGROUND
  Providing current, reliable and evidence based information for clinicians and researchers in a synthesised and summarised way can be challenging particularly in the area of traumatic brain injury where a vast number of reviews exists. These reviews vary in their methodological quality and are scattered across varying sources. In this paper, we present an overview of systematic reviews that evaluate the pharmacological interventions in traumatic brain injury (TBI). By doing this, we aim to evaluate the existing evidence for improved outcomes in TBI with pharmacological interventions, and to identify gaps in the literature to inform future research.
  
  
  METHODS
  We searched the Neurotrauma Evidence Map on systematic reviews relating to pharmacological interventions for managing TBI in acute phase. Two reviewers independently screened search results and appraised each systematic review using the validated AMSTAR tool and extracted data from the review.
  
  
  RESULTS
  A total of 288 systematic reviews relating to TBI were available on the Neurotrauma Evidence Map at the time of this study. We identified 19 systematic reviews on pharmacological management for acute TBI with publications dates ranging from 1998 to 2014. The studies were of varying methodological quality, with a mean AMSTAR score of 7.78 (range 2-11].
  
  
  CONCLUSIONS
  The evidence from high quality systematic reviews show that there is currently insufficient evidence for the use of magnesium, monoaminergic and dopamine agonists, progesterone, aminosteroids, excitatory amino acid inhibitors, haemostatic and antifibrinolytic drugs in TBI. Anti-convulsants are only effective in reducing early seizures with no significant difference between phenytoin and leviteracetam. There is no difference between propofol and midazolam for sedation in TBI patients and ketamine may not cause increased ICP. Overviews of systematic review provide informative and powerful summaries of evidence based research.
authors.affiliation: Alfred Health, Melbourne 3004, Vic, Australia; National Trauma Research Institute, Vic, Australia; Queen Mary University of London and Barts and The London School of Medicine and Dentistry, London, UK. Electronic address: riz.gultekin@gmail.com.
authors.forename: Riza
authors.initials: R
authors.lastname: Gultekin
authors.affiliation: Alfred Health, Melbourne 3004, Vic, Australia.
authors.forename: Sean
authors.initials: S
authors.lastname: Huang
authors.affiliation: National Trauma Research Institute, Vic, Australia.
authors.forename: Ornella
authors.initials: O
authors.lastname: Clavisi
authors.affiliation: National Trauma Research Institute, Vic, Australia.
authors.forename: Loyal
authors.initials: L
authors.lastname: Pattuwage
authors.affiliation: Queen Mary University of London and Barts and The London School of Medicine and Dentistry, London, UK.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: König
authors.affiliation: Alfred Health, Melbourne 3004, Vic, Australia; National Trauma Research Institute, Vic, Australia.
authors.forename: Russell
authors.initials: R
authors.lastname: Gruen
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use*; D035843:Biomedical Research / Q000639:trends; D000070642:Brain Injuries, Traumatic / Q000188:drug therapy* / Q000503:physiopathology / Q000534:rehabilitation; D018491:Dopamine Agonists / Q000627:therapeutic use*; D019317:Evidence-Based Medicine; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D011374:Progesterone / Q000627:therapeutic use*
chemical_list: D000927:Anticonvulsants; D018491:Dopamine Agonists; D006993:Hypnotics and Sedatives; D011374:Progesterone
keywords: Acute brain injury; Evidence-based medicine; Pharmacology; Systematic review; Trauma