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Latest & greatest articles for traumatic brain injury
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Modest cooling therapies (35 degrees C to 37.5 degrees C) for traumaticbraininjury. BACKGROUND: A recent retrospective study suggested that after traumaticbraininjury, patients with a raised body temperature have an unfavourable outcome compared to patients that have a normal body temperature. OBJECTIVES: To assess the effects of modest cooling therapies (defined as any drug or physical therapy aimed at maintaining body temperature between 35 degrees C and 37.5 degrees C) when applied (...) to patients in the first week after traumaticbraininjury. SEARCH STRATEGY: We searched the Cochrane Injuries Group's Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, Issue 3), MEDLINE (1950 to 2008), EMBASE (1980 to 2008), the National Research Register, Zetoc and the Current Controlled Trials MetaRegister of controlled trials. We also contacted investigators, pharmaceutical companies and the manufacturers of cooling equipment. The searches
Fitness training for cardiorespiratory conditioning after traumaticbraininjury. BACKGROUND: Cardiorespiratory deconditioning is a common sequelae after traumaticbraininjury (TBI). Clinically, fitness training is implemented to address this impairment, however this intervention has not been subject to rigorous review. OBJECTIVES: The primary objective was to evaluate whether fitness training improves cardiorespiratory fitness in people who have sustained a TBI. SEARCH STRATEGY: We searched (...) ten electronic databases (Cochrane Injuries Group Trials Register; Cochrane Central Register of Controlled Trials (CENTRAL); EMBASE; PubMed (MEDLINE); CINAHL; AMED; SPORTDiscus; PsycINFO; PEDro and PsycBITE) and two clinical trials registers (TrialsCentral and Current Controlled Trials). The last search was August 2007. In addition we screened reference lists from included studies and contacted trialists to identify further studies. SELECTION CRITERIA: Randomised controlled studies with TBI
Predicting outcome after traumaticbraininjury: practical prognostic models based on large cohort of international patients. OBJECTIVE: To develop and validate practical prognostic models for death at 14 days and for death or severe disability six months after traumaticbraininjury. DESIGN: Multivariable logistic regression to select variables that were independently associated with two patient outcomes. Two models designed: "basic" model (demographic and clinical variables only) and "CT (...) " model (basic model plus results of computed tomography). The models were subsequently developed for high and low-middle income countries separately. SETTING: Medical Research Council (MRC) CRASH Trial. SUBJECTS: 10,008 patients with traumaticbraininjury. Models externally validated in a cohort of 8509. RESULTS: The basic model included four predictors: age, Glasgow coma scale, pupil reactivity, and the presence of major extracranial injury. The CT model also included the presence of petechial
Treatment efficacy of social communication skills training after traumaticbraininjury: a randomized treatment and deferred treatment controlled trial. 18047870 2007 11 30 2007 12 11 2015 11 19 1532-821X 88 12 2007 Dec Archives of physical medicine and rehabilitation Arch Phys Med Rehabil Treatment efficacy of social communication skills training after traumaticbraininjury: a randomized treatment and deferred treatment controlled trial. 1561-73 To evaluate the efficacy of a replicable group (...) treatment program to improve social communication skills after traumaticbraininjury (TBI). Randomized treatment and deferred treatment controlled trial, with follow-up at 3, 6, and 9 months post-treatment. Community. Volunteer sample of 52 people with TBI who were at least 1 year postinjury, who received rehabilitation, and who had identified social communication deficits. Twelve weekly group sessions (1.5 h each) to improve social communication. The Profile of Functional Impairment in Communication
Mild traumaticbraininjury in U.S. Soldiers returning from Iraq. BACKGROUND: An important medical concern of the Iraq war is the potential long-term effect of mild traumaticbraininjury, or concussion, particularly from blast explosions. However, the epidemiology of combat-related mild traumaticbraininjury is poorly understood. METHODS: We surveyed 2525 U.S. Army infantry soldiers 3 to 4 months after their return from a year-long deployment to Iraq. Validated clinical instruments were used (...) to compare soldiers reporting mild traumaticbraininjury, defined as an injury with loss of consciousness or altered mental status (e.g., dazed or confused), with soldiers who reported other injuries. RESULTS: Of 2525 soldiers, 124 (4.9%) reported injuries with loss of consciousness, 260 (10.3%) reported injuries with altered mental status, and 435 (17.2%) reported other injuries during deployment. Of those reporting loss of consciousness, 43.9% met criteria for post-traumatic stress disorder (PTSD), as
Beta-2 receptor antagonists for acute traumaticbraininjury. BACKGROUND: Traumaticbraininjury (TBI) is a leading cause of death and disability worldwide. Cerebral oedema, the accumulation of fluid within the brain, is believed to be an important contributor to the secondary brain damage that occurs following injury. The release of kinins is thought to be an important factor in the development of cerebral vasogenic oedema and the use of beta-2 receptor antagonists, which prevent the release (...) of these kinins, have been proposed as a potential therapeutic intervention. OBJECTIVES: The objective was to assess the safety and effectiveness of beta-2 receptor antagonists for TBI. SEARCH STRATEGY: We searched the Cochrane Injuries Group's specialised register, CENTRAL, MEDLINE, EMBASE, National Research Register, LILACs, Zetoc, Web of Knowledge and Current Controlled Trials. We also searched the internet and checked the reference lists of relevant papers to identify any further studies. The searches
Hypothermia treatment for traumaticbraininjury: a systematic review and meta-analysis Hypothermia treatment for traumaticbraininjury: a systematic review and meta-analysis Hypothermia treatment for traumaticbraininjury: a systematic review and meta-analysis Peterson K, Carson S, Carney N CRD summary The authors concluded that in specific circumstances hypothermia may reduce mortality and increase the likelihood of a favourable neurological outcome in adults with traumaticbraininjury (...) : more research is needed. Although the review was well conducted in many respects, these conclusions may need to be regarded cautiously, given the rather limited search and the questionable quality of the primary studies. Authors' objectives To evaluate the safety and effectiveness of hypothermia for treating adults with traumaticbraininjury (TBI). Searching Four previously published systematic reviews were hand searched for relevant studies (see Other publications of related interest). Search
Routine serial computed tomographic scans in mild traumaticbraininjury: when are they cost-effective? Routine serial computed tomographic scans in mild traumaticbraininjury: when are they cost-effective? Routine serial computed tomographic scans in mild traumaticbraininjury: when are they cost-effective? Stein S C, Fabbri A, Servadei F Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief (...) summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. CRD summary This study assessed the cost-effectiveness of routine serial scanning of the head, compared with a strategy of awaiting clinical deterioration before repeating the diagnostic study, in patients with mild traumaticbraininjury. It was concluded that a modest efficacy gain made the strategy of routine scanning cost-effective, especially
Cerebral blood flow thresholds for cerebral ischemia in traumaticbraininjury: a systematic review Cerebral blood flow thresholds for cerebral ischemia in traumaticbraininjury: a systematic review Cerebral blood flow thresholds for cerebral ischemia in traumaticbraininjury: a systematic review Botteri M, Bandera E, Minelli C, Latronico N CRD summary This well-conducted review only identified one study that fulfilled the inclusion criteria. The authors' conclusion that there is insufficient (...) evidence to recommend the use of cerebral blood flow thresholds for the diagnosis of post-traumatic cerebral ischaemia is likely to be reliable. Authors' objectives To determine the methodologic adequacy of cerebral blood flow thresholds in adults with traumaticbraininjury. Searching MEDLINE (1966 to June 2007), EMBASE (1982 to June 2007) and the Cochrane Library (1993 to June 2007) were searched. Search terms were reported. References of relevant studies were screened and experts in the area
Cognitive rehabilitation for traumaticbraininjury in adults Cognitive rehabilitation for traumaticbraininjury in adults Cognitive rehabilitation for traumaticbraininjury in adults BlueCross BlueShield Association Record Status This is a bibliographic record of a published health technology assessment. No evaluation of the quality of this assessment has been made for the HTA database. Citation BlueCross BlueShield Association. Cognitive rehabilitation for traumaticbraininjury in adults (...) rehabilitation does not show strong evidence for efficacy in the treatment of traumaticbraininjury. Many of the clinical trials of specific cognitive rehabilitation interventions evaluated cognitive tests rather than health outcomes. Demonstration of the effectiveness of cognitive rehabilitation, either as an integrated holistic program, or as a separable component that treats a specific cognitive defect, requires prospective randomized designs that employ validated measures of health outcomes. Based
The effectiveness of donepezil for cognitive rehabilitation after traumaticbraininjury: a systematic review The effectiveness of donepezil for cognitive rehabilitation after traumaticbraininjury: a systematic review The effectiveness of donepezil for cognitive rehabilitation after traumaticbraininjury: a systematic review Ballesteros J, Guemes I, Ibarra N, Quemada JI CRD summary This review determined the effectiveness and safety of donepezil for cognitive rehabilitation after traumatic (...) braininjury and found significant evidence for a positive effect on general cognitive ability, short-term memory and attention. The authors' appropriately cautious conclusion was that the effectiveness and safety of donepezil were uncertain due to the limited evidence available. Authors' objectives To determine the effectiveness and safety of donepezil for cognitive rehabilitation after traumaticbraininjury. Searching PubMed, PsycINFO and Cochrane Central Register of Controlled Trials (CENTRAL
Intervention for executive functions after traumaticbraininjury: a systematic review, meta-analysis and clinical recommendations Intervention for executive functions after traumaticbraininjury: a systematic review, meta-analysis and clinical recommendations Intervention for executive functions after traumaticbraininjury: a systematic review, meta-analysis and clinical recommendations Kennedy MR, Coelho C, Turkstra L, Ylvisaker M, Moore Sohlberg M, Yorkston K, Chiou HH, Kan PF CRD summary (...) The authors concluded that metacognitive strategy instruction should be used to improve everyday functional problems in young to middle-aged adults with traumaticbraininjury. Further research was required. Incomplete reporting of review methods and study quality, and concerns about individual studies results and meta-analysis methods undermined the reliability of the authors’ conclusions. Authors' objectives To evaluate the effects of interventions focused on executive functions (problem solving
Early modifiable factors associated with fatal outcome in patients with severe traumaticbraininjury: a case control study PEDSCCM.org Criteria abstracted from series in Review Posted: founded 1995 Questions or comments?
Serial casting versus positioning for the treatment of elbow contractures in adults with traumaticbraininjury: a randomized controlled trial 18441037 2008 04 28 2008 09 11 2008 04 28 0269-2155 22 5 2008 May Clinical rehabilitation Clin Rehabil Serial casting versus positioning for the treatment of elbow contractures in adults with traumaticbraininjury: a randomized controlled trial. 406-17 10.1177/0269215507083795 To compare the effects of serial casting with positioning for 1 hour per day (...) for the treatment of elbow flexion contracture in adults with traumaticbraininjury. Pragmatic randomized controlled trial with concealed allocation and assessor blinding. Four braininjury rehabilitation units. Twenty-six adults with elbow flexion contracture after traumaticbraininjury participating in multidisciplinary inpatient rehabilitation. Subjects were randomized to receive either serial casting or positioning for two weeks. In the subsequent four weeks subjects could be positioned for up to 1 hour
Hypothermia therapy after traumaticbraininjury in children. 18525042 2008 06 05 2008 06 19 2010 11 18 1533-4406 358 23 2008 Jun 05 The New England journal of medicine N. Engl. J. Med. Hypothermia therapy after traumaticbraininjury in children. 2447-56 10.1056/NEJMoa0706930 Hypothermia therapy improves survival and the neurologic outcome in animal models of traumaticbraininjury. However, the effect of hypothermia therapy on the neurologic outcome and mortality among children who have (...) severe traumaticbraininjury is unknown. In a multicenter, international trial, we randomly assigned children with severe traumaticbraininjury to either hypothermia therapy (32.5 degrees C for 24 hours) initiated within 8 hours after injury or to normothermia (37.0 degrees C). The primary outcome was the proportion of children who had an unfavorable outcome (i.e., severe disability, persistent vegetative state, or death), as assessed on the basis of the Pediatric Cerebral Performance Category
Psychological treatment for anxiety in people with traumaticbraininjury. BACKGROUND: Psychological treatments are commonly used in the management of anxiety. Certain types of psychological treatments are well suited to needs of people with traumaticbraininjury (TBI). We have systematically reviewed studies examining the effectiveness of these approaches for TBI. OBJECTIVES: To assess the effects of psychological treatments for anxiety in people with TBI. SEARCH STRATEGY: We searched (...) the following databases up until March 2006: Cochrane Injuries Group's specialised register, Cochrane Depression, Anxiety and Neurosis Group's specialised register, Cochrane Central Register of Controlled Trials, MEDLINE, PsycINFO, EMBASE, CINAHL, AMED, ERIC, and PsycBITE. Additionally, key journals were handsearched and reference lists of included trials were examined to identify further studies meeting inclusion criteria. SELECTION CRITERIA: Randomised controlled trials of psychological treatments
Mannitol for acute traumaticbraininjury. BACKGROUND: Mannitol is sometimes effective in reversing acute brain swelling, but its effectiveness in the ongoing management of severe head injury remains unclear. There is evidence that, in prolonged dosage, mannitol may pass from the blood into the brain, where it might cause increased intracranial pressure. OBJECTIVES: To assess the effects of different mannitol therapy regimens, of mannitol compared to other intracranial pressure (ICP) lowering (...) agents, and to quantify the effectiveness of mannitol administration given at other stages following acute traumaticbraininjury. SEARCH STRATEGY: The review drew on the search strategy for the Injuries Group as a whole. We checked reference lists of trials and review articles, and contacted authors of trials. The searches were last updated in March 2006. SELECTION CRITERIA: Randomised controlled trials of mannitol, in patients with acute traumaticbraininjury of any severity. The comparison group
Cost-effectiveness of head computed tomography in infants with possible inflicted traumaticbraininjury Cost-effectiveness of head computed tomography in infants with possible inflicted traumaticbraininjury Cost-effectiveness of head computed tomography in infants with possible inflicted traumaticbraininjury Campbell K A, Berger R P, Ettaro L, Roberts M S Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract (...) contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. Health technology The study examined the use of computed tomography of the head (head CT) for the diagnosis of inflicted traumaticbraininjury (iTBI) in selected infants. Head CT was compared with a policy of no CT. Type of intervention Diagnosis. Economic study type Cost-effectiveness analysis Study population The study population
Functional imaging screening for traumaticbraininjury Functional imaging screening for traumaticbraininjury Functional imaging screening for traumaticbraininjury Flynn K 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 database. Citation Flynn K. Functional imaging screening for traumaticbraininjury. Boston: VA Technology Assessment Program (VATAP (...) -and post-deployment. Finally, the single available systematic review of functional imaging in MTBI (Davalos, 2007) does focus on SPECT but provides no support for, and no mention of, use of this imaging in screening. Project page URL Indexing Status Subject indexing assigned by CRD MeSH BrainInjuries /diagnosiss; Mass Screening; Review Language Published English Country of organisation United States Address for correspondence Office of Patient Care Services (11T), VA Boston Healthcare System Room 4D