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Latest & greatest articles for traumatic brain injury
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Effect of tranexamic acid in traumaticbraininjury: a nested randomised, placebo controlled trial (CRASH-2 Intracranial Bleeding Study). To assess the effect of tranexamic acid (which reduces bleeding in surgical patients and reduces mortality due to bleeding in trauma patients) on intracranial haemorrhage in patients with traumaticbrain injury.A nested, randomised, placebo controlled trial. All investigators were masked to treatment allocation. All analyses were by intention to treat (...) . Patients 270 adult trauma patients with, or at risk of, significant extracranial bleeding within 8 hours of injury, who also had traumaticbrain injury.Patients randomly allocated to tranexamic acid (loading dose 1 g over 10 minutes, then infusion of 1 g over 8 hours) or matching placebo.Intracranial haemorrhage growth (measured by computed tomography) between hospital admission and then 24-48 hours later, with adjustment for Glasgow coma score, age, time from injury to the scans, and initial
Predictors of extended rehabilitation length of stay after traumaticbraininjury To develop a prediction rule for acutely identifying patients at risk for extended rehabilitation length of stay (LOS) after traumaticbraininjury (TBI) by using demographic and injury characteristics.Retrospective cohort study.Traumatic BrainInjury Model Systems.Sample of TBI survivors (N=7284) with injuries occurring between 1999 and 2009.Not applicable.Extended rehabilitation LOS defined as 67 days (...) or longer.A multivariable model was built containing FIM motor and cognitive scores at admission, preinjury level of education, cause of injury, punctate/petechial hemorrhage, acute-care LOS, and primary payor source. The model had good calibration, excellent discrimination (area under the receiver operating characteristic curve = .875), and validated well. Based on this model, a formula for determining the probability of extended rehabilitation LOS and a prediction rule that classifies patients
/ OR exp BRAININJURIES/ OR exp CRANIOCEREBRAL TRAUMA/ OR exp WOUNDS, NONPENETRATING/ OR exp CEREBRAL HEMORRHAGE/ OR exp BRAIN CONCUSSION Limited to children (age Search Outcome 606 papers were found. There were many review articles and several trials reporting biochemical or intracranial pressure outcomes, but only 3 trials presented survival data in children. Details of these papers are shown in the table. Relevant Paper(s) Author, date and country Patient group Study type (level of evidence (...) . A Phase III study is currently recruiting patients in a multicenter randomised trial that applies increased standardisation of variables. The outcome of this trial is eagerly awaited and may change the management of children after TBI. Editor Comment GCS, Glasgow Coma Scale; ICP, intracranial pressure; RCT, randomised controlled trial; TBI, traumaticbraininjury. Clinical Bottom Line There is insufficient evidence at the moment to support therapeutic hypothermia in paediatric patients presenting
Intensive insulin therapy in severe traumaticbraininjury: a randomized trial Intensive insulin therapy (IIT) has been shown to reduce morbidity and mortality in critically ill patients. Little investigation has been done to find out whether it improves the prognosis of patients with severe traumaticbraininjury (STBI).We conducted a prospective controlled study where adult patients with blunt STBI, with Glasgow Coma Scale
Rates of major depressive disorder and clinical outcomes following traumaticbraininjury. Uncertainties exist about the rates, predictors, and outcomes of major depressive disorder (MDD) among individuals with traumaticbraininjury (TBI).To describe MDD-related rates, predictors, outcomes, and treatment during the first year after TBI.Cohort from June 2001 through March 2005 followed up by structured telephone interviews at months 1 through 6, 8, 10, and 12 (data collection ending February (...) and 21% at 6 months. In a multivariate model, risk of MDD after TBI was associated with MDD at the time of injury (risk ratio [RR], 1.62; 95% confidence interval [CI], 1.37-1.91), history of MDD prior to injury (but not at the time of injury) (RR, 1.54; 95% CI, 1.31-1.82), age (RR, 0.61; 95% CI, 0.44-0.83 for > or = 60 years vs 18-29 years), and lifetime alcohol dependence (RR, 1.34; 95% CI, 1.14-1.57). Those with MDD were more likely to report comorbid anxiety disorders after TBI than those without
Haemostatic drugs for traumaticbraininjury. Traumaticbraininjury (TBI) is a leading cause of death and disability. Intracranial bleeding is a common complication of TBI, and intracranial bleeding can develop or worsen after hospital admission. Haemostatic drugs may reduce the occurrence or size of intracranial bleeds and consequently lower the morbidity and mortality associated with TBI.To assess the effects of haemostatic drugs on mortality, disability and thrombotic complications (...) in patients with traumaticbrain injury.We searched the electronic databases: Cochrane Injuries Group Specialised Register (3 February 2009), CENTRAL (The Cochrane Library 2009, Issue 1), MEDLINE (1950 to Week 3 2009), PubMed (searched 3 February 2009 (last 180 days)), EMBASE (1980 to Week 4 2009), CINAHL (1982 to January 2009), ISI Web of Science: Science Citation Index Expanded (SCI-EXPANDED) (1970 to January 2009), ISI Web of Science: Conference Proceedings Citation Index - Science (CPCI-S) (1990
delivered) separately and in combination compared with standard care in a cohort of ventilated subjects with an acute severe TBI (GCS score ≤ 8) within 24 hours of injury. Subjects received hyperoxia treatments every 24 hours for three treatment sessions. HBO2 delivered to achieve a brain tissue P02 > 200 mm Hg has a greater positive effect than normobaric hyperoxia therapy on oxidative cerebral metabolism and intracranial pressure. Effect was sustained for at least six hours post treatment over (...) Hyperbaric oxygen therapy for traumaticbraininjury (TBI) and post traumatic stress disorder (PTSD) Hyperbaric oxygen therapy for traumaticbraininjury (TBI) and post traumatic stress disorder (PTSD) Hyperbaric oxygen therapy for traumaticbraininjury (TBI) and post traumatic stress disorder (PTSD) Adams E Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA
Out-of-hospital hypertonic resuscitation following severe traumaticbraininjury: a randomized controlled trial. Hypertonic fluids restore cerebral perfusion with reduced cerebral edema and modulate inflammatory response to reduce subsequent neuronal injury and thus have potential benefit in resuscitation of patients with traumaticbraininjury (TBI).To determine whether out-of-hospital administration of hypertonic fluids improves neurologic outcome following severe TBI.Multicenter, double
with hypothermia, and rebound in intracranial pressure associated with rewarming (three RCTs of short-term cooling). The funnel plot was suggestive of publication bias; small negative studies were less likely to be published. Sensitivity analysis by quality did not change the overall findings. Authors' conclusions Early prophylactic mild to moderate hypothermia improved mortality and functional outcomes after severe traumaticbraininjury, especially when a long-term or goal-directed cooling strategy was used (...) as possible after injury regardless of intracranial pressure. They stated that the best results occurred with a long-term or goal-directed cooling protocol. Research : The authors stated that there was wide scope for more research on prophylactic hypothermia for traumaticbraininjury in pre-hospital and emergency department settings; they noted that five studies were ongoing. The authors recommended that more research in this field be conducted by Western researchers as most of the long-term studies were
Cost-effectiveness analysis of intravenous levetiracetam versus intravenous phenytoin for early onset seizure prophylaxis after neurosurgery and traumaticbraininjury Cost-effectiveness analysis of intravenous levetiracetam versus intravenous phenytoin for early onset seizure prophylaxis after neurosurgery and traumaticbraininjury Cost-effectiveness analysis of intravenous levetiracetam versus intravenous phenytoin for early onset seizure prophylaxis after neurosurgery and traumaticbrain (...) after neurosurgery or traumaticbraininjury, in the intensive care unit setting. The authors concluded that, from the perspective of the hospital, levetiracetam could be cost-effective compared with phenytoin. The methods were valid and the study was generally well presented. The authors’ conclusions seem robust. Type of economic evaluation Cost-effectiveness analysis Study objective This study examined the cost-effectiveness of intravenous levetiracetam, compared with conventional intravenous
Nursing management of adults with severe traumaticbraininjury. Guidelines and Measures | Agency for Healthcare Research & Quality HHS.gov Search ahrq.gov Search ahrq.gov Menu Topics A - Z Healthcare Delivery Latest available findings on quality of and access to health care Searchable database of AHRQ Grants, Working Papers & HHS Recovery Act Projects AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund You are here Guidelines and Measures Funding for the National
Interventions for apathy after traumaticbraininjury. Apathy is a deficiency in overt behavioural, emotional and cognitive components of goal-directed behaviour. It is a common occurrence after traumaticbraininjury (TBI), with widespread impact. We have systematically reviewed studies examining the effectiveness of interventions for apathy in the TBI population.To investigate the effectiveness of interventions for apathy in adults who have sustained a TBI. This was evaluated by changes (...) in behavioural, cognitive and emotional measures of apathy.We searched the following databases up to January 2008: CENTRAL (The Cochrane Library 2008, Issue 1), Database of Abstracts of Reviews of Effects, ACP Journal Club, MEDLINE (1950 to Jan 2008), EMBASE (1980 to Jan 2008), PsycINFO (1806 to Jan 2008), CINAHL (1982 Jan 2008), PsycBITE, AMED (1985 to Jan 2008), www.controlled-trials.com, www.clinicaltrials.gov and www.actr.org.au.The Cochrane Injuries Group's Specialised Register was searched to Jan 2009
features examined as predictors of postconcussive symptoms included loss of consciousness, Glasgow Coma Scale score below 15, other injuries, acute symptoms of concussion, and intracranial abnormalities on the MRI.Finite mixture modeling identified 4 longitudinal trajectories of postconcussive symptoms (ie, no postconcussive symptoms, moderate persistent postconcussive symptoms, high acute/resolved postconcussive symptoms, high acute/persistent postconcussive symptoms). The mild traumaticbrain (...) Longitudinal trajectories of postconcussive symptoms in children with mild traumaticbraininjuries and their relationship to acute clinical status We examined whether mild traumaticbraininjuries in children and adolescents, especially when associated with acute clinical features reflecting more severe injury, result in different postinjury trajectories of postconcussive symptoms compared with mild orthopedic injuries.Participants in this prospective and longitudinal cohort study were 8
of correctly classifying patients as having surgical, nonsurgical, or no intracranial lesions.We performed a secondary analysis of prospectively collected database from 7,955 patients aged 10 years or older with mild traumaticbraininjury to compare sensitivity and specificity of 6 common clinical decision strategies: the Canadian CT Head Rule, the Neurotraumatology Committee of the World Federation of Neurosurgical Societies, the New Orleans, the National Emergency X-Radiography Utilization Study II (...) A critical comparison of clinical decision instruments for computed tomographic scanning in mild closed traumaticbraininjury in adolescents and adults A number of clinical decision aids have been introduced to limit unnecessary computed tomographic scans in patients with mild traumaticbraininjury. These aids differ in the risk factors they use to recommend a scan. We compare the instruments according to their sensitivity and specificity and recommend ones based on incremental benefit
Long-term risk of epilepsy after traumaticbraininjury in children and young adults: a population-based cohort study. The risk of epilepsy shortly after traumaticbraininjury is high, but how long this high risk lasts is unknown. We aimed to assess the risk of epilepsy up to 10 years or longer after traumaticbraininjury, taking into account sex, age, severity, and family history.We identified 1 605 216 people born in Denmark (1977-2002) from the Civil Registration System. We obtained (...) information on traumaticbraininjury and epilepsy from the National Hospital Register and estimated relative risks (RR) with Poisson analyses.Risk of epilepsy was increased after a mild braininjury (RR 2.22, 95% CI 2.07-2.38), severe braininjury (7.40, 6.16-8.89), and skull fracture (2.17, 1.73-2.71). The risk was increased more than 10 years after mild braininjury (1.51, 1.24-1.85), severe braininjury (4.29, 2.04-9.00), and skull fracture (2.06, 1.37-3.11). RR increased with age at mild and severe
TraumaticBrainInjury and PTSD: A Synthesis of the Evidence Management Briefs Enter search terms Button to search HSRD ® Inside VA Budget and Performance Inside the News Room National Observances Special Events » » » » » Management Briefs Health Services Research & Development Management Briefs Management eBriefs: Provide VA senior managers with results from VA Health Services Research in a concise and timely manner. , April 2019, Issue 152 , March 2019, Issue 151 , March 2019, Issue 150
A systematic review of psychological treatments for mild traumaticbraininjury: an update on the evidence Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.
Treatment for depression after traumaticbraininjury: a systematic review Untitled Document The CRD Databases will not be available from 08:00 BST on Friday 4th October until 08:00 BST on Monday 7th October for essential maintenance. We apologise for any inconvenience.