An umbrella review of health outcomes following traumatic brain injury

Abstract

While numerous reviews have assessed the association between traumatic brain injury (TBI) and various mental and physical health outcomes, a comprehensive evaluation of the scope, validity, and quality of evidence is lacking. Here we present an umbrella review of a wide range of health outcomes following TBI and outline outcome risks across subpopulations. On 17 May 2023, we searched Embase, Medline, Global Health, PsycINFO, and Cochrane Database of Systematic Reviews for systematic reviews and meta-analyses. We compared risk ratios across different outcomes for risks compared with people without TBI and examined study quality, including heterogeneity, publication bias, and prediction intervals. The study was registered with PROSPERO (CRD42023432255). We identified 24 systematic reviews and meta-analyses covering 24 health outcomes in 31,397,958 participants. The current evidence base indicates an increased risk of multiple mental and physical health outcomes, including psychotic disorders, attention-deficit/hyperactivity disorder, suicide, and depression. Three outcomes-dementia, violence perpetration, and amyotrophic lateral sclerosis-had meta-analytical evidence of at least moderate quality, which suggest targets for more personalized assessment. Health-care services should review how to prevent adverse long-term outcomes in TBI.

Keywords: Brain injuries; Psychology; Public health.

Fig. 1. PRISMA flow diagram.

Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram.

Fig. 2. Risk estimates of health outcomes following TBI stratified by injury severity.

Data are presented as RR ± CI.

Fig. 3. AMSTAR 2 scores across domains.

Items covering the appropriateness of the meta-analytical methods (items 11, 12, and 15) were not applicable for systematic reviews. 'PICO' refers to population, intervention, control, and outcomes.