Low-value clinical practices in adult traumatic brain injury: an umbrella review protocol

Abstract

IntroductionTraumatic brain injury (TBI) leads to 50 000 deaths, 85 000 disabilities and costs $60 billion each year in the USA. Despite numerous interventions and treatment options, the outcomes of TBI have improved little over the last three decades. In a previous scoping review and expert consultation survey, we identified 13 potentially low-value clinical practices in acute TBI. The objective of this umbrella review is to synthesise the evidence on potentially low-value clinical practices in the care of acute TBI.Methods and analysisUsing umbrella review methodology, we will search Cochrane Central Register of Controlled Trials, Embase, Epistemonikos, International Prospective Register of Systematic Reviews (PROSPERO) and PubMed to identify systematic reviews evaluating the effect of potential intrahospital low-value practices using tailored population, intervention, comparator, outcome and study design questions based on the results of a previous scoping review. We will present data on the methodological quality of these reviews (Assessing the Methodological Quality of Systematic Reviews-2), reported effect sizes and strength of evidence (Grading of Recommendations, Assessment, Development and Evaluation).Ethics and disseminationEthics approval is not required as original data will not be collected. Knowledge users from five healthcare quality organisations and clinical associations are involved in the design and conduct of the study. Results will be disseminated in a peer-reviewed journal, at international scientific meetings and to clinical, healthcare quality and patient–partner associations. This work will support the development of metrics to measure the use of low-value practices, inform policy makers on potential targets for deimplementation and in the long term reduce the use of low-value clinical practices in acute TBI care.PROSPERO registration numberCRD42019132428.

Quality Indicators Targeting Low-Value Clinical Practices in Trauma Care

“…29,30 In a subsequent phase, we synthesized the evidence base for each of these practices using umbrella review (ie, review of reviews) and rapid review methodology in collaboration with Cochrane Canada. [31][32][33] We then estimated the frequency of practices that could be evaluated using trauma registry data from a Canadian provincial trauma system. 10…”

“…This study was based on 50 potentially low-value clinical practices previously identified in a scoping review and expert consultation survey (36 clinicians; participation rate = 92%), explained in detail elsewhere . In a subsequent phase, we synthesized the evidence base for each of these practices using umbrella review (ie, review of reviews) and rapid review methodology in collaboration with Cochrane Canada . We then estimated the frequency of practices that could be evaluated using trauma registry data from a Canadian provincial trauma system …”

Low-Value Clinical Practices in Adult Traumatic Brain Injury: An Umbrella Review

“…[22][23][24] In the absence of reporting guidelines for umbrella reviews, we used applicable Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). [25] The protocol was published [26] and registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42019132428). An ethics waiver was obtained from the CHU de Québec -Université Laval research ethics board.…”

“…[38] For each lowvalue practice and each review, we present the number of studies according to their design, the sample size, the quality of the reviews (AMSTAR-2), measures of association for primary and secondary outcomes with their measures of heterogeneity, reported risk of bias for included studies, and reported strength of evidence (GRADE). [26] As GRADE was only used in 6/44 systematic reviews, we also evaluated evidence with credibility of evidence criteria used in previous umbrella reviews. [39,40] These criteria class evidence from meta-analyses into four categories: convincing (class I), highly suggestive (class II), suggestive (class III), weak (class IV) and non-significant (NS), based on statistical significance, sample size, heterogeneity and risk of bias.…”

The interaction of the circadian and immune system: Desynchrony as a pathological outcome to traumatic brain injury

“…Given that it is estimated that between 70 and 90% of all brain injuries are mild in severity ( Dewan et al, 2018 ), and these types of injuries often go untreated, the true incidence of TBI is difficult to assess ( Cassidy et al, 2004 ). Despite this, the healthcare costs of TBI have been estimated to be approximately 60 billion USD yearly ( Coronado et al, 2015 ; Tardif et al, 2019 ). Particularly troublesome is the incidence of childhood or adolescent TBI, or multiple TBIs, which are commonly associated with sports, recreation, and drug or alcohol use, as this age group is undergoing critical brain development ( Gogtay et al, 2004 ; Livingston et al, 2017 ).…”