The Australian Traumatic Brain Injury Initiative: Systematic Review of Clinical Factors Associated with Outcomes in People with Moderate-Severe Traumatic Brain Injury

Abstract

The aim of the Australian Traumatic Brain Injury Initiative (AUS-TBI) is to design a data dictionary to inform data collection and facilitate prediction of outcomes for moderate-severe traumatic brain injury (TBI) across Australia. The process has engaged diverse stakeholders across six areas: social, health, clinical, biological, acute interventions, and long-term outcomes. Here, we report the results of the clinical review. Standardized searches were implemented across databases to April 2022. English-language reports of studies evaluating an association between a clinical factor and any clinical outcome in at least 100 patients with moderate-severe TBI were included. Abstracts, and full-text records, were independently screened by at least two reviewers in Covidence. The findings were assessed through a consensus process to determine inclusion in the AUS-TBI data resource. The searches retrieved 22,441 records, of which 1137 were screened at full text and 313 papers were included. The clinical outcomes identified were predominantly measures of survival and disability. The clinical predictors most frequently associated with these outcomes were the Glasgow Coma Scale, pupil reactivity, and blood pressure measures. Following discussion with an expert consensus group, 15 were recommended for inclusion in the data dictionary. This review identified numerous studies evaluating associations between clinical factors and outcomes in patients with moderate-severe TBI. A small number of factors were reported consistently, however, how and when these factors were assessed varied. The findings of this review and the subsequent consensus process have informed the development of an evidence-informed data dictionary for moderate-severe TBI in Australia.

Keywords: Glasgow Coma Scale; MeSH term; common data elements; critical care; emergency medical services; health care outcome assessment; multiple trauma; physical examination; systematic review; trauma severity indices; traumatic brain injuries; vital signs.

FIG. 1.

PRISMA flow diagram.

FIG. 2.

Word cloud of clinical predictors of outcome (size of word denotes frequency in included records). AIS, Abbreviated Injury Scale; ASCOT, A Severity Characterisation of Trauma; APACHE, Acute Physiology and Chronic Health Evaluation; PRISM, Paediatric Risk of Mortality Score; PTA, post-traumatic amnesia; RTS, Revised Trauma Score; SAPS, Simplified Acute Physiology Score (SAPS) II.

FIG. 3.

Word cloud of outcomes assessed against the clinical factors (size of word denotes frequency in included records). GCS, Glasgow Coma Scale; GOSE, Glasgow Outcome Scale-Extended; PCPCS, Paediatric Cerebral Performance Category Scale.