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Protocol for a systematic review and meta-analysis of long-term neurocognitive outcomes in paediatric traumatic brain injury
  1. Dawn Shu Hui Looi1,
  2. Mark Sen Liang Goh2,
  3. Sharon Si Min Goh3,
  4. Jia Ling Goh4,
  5. Rehena Sultana5,
  6. Jan Hau Lee6,
  7. Shu-Ling Chong7
  1. 1Lee Kong Chian School of Medicine, Singapore
  2. 2Duke-NUS Medical School, Singapore
  3. 3Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
  4. 4NUS Yong Loo Lin School of Medicine, Singapore
  5. 5Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
  6. 6Children's Intensive Care Unit, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore
  7. 7Department of Emergency Medicine, KK Women's and Children's Hospital, Duke-NUS Medical School, Singapore
  1. Correspondence to Dr Shu-Ling Chong; chong.shu-ling{at}


Introduction Children who suffer from traumatic brain injury (TBI) are at risk of permanent brain damage and developmental deficits. Reports on neurodevelopmental outcomes in paediatric TBI suffer from small sample size and varying outcome definitions in the neurocognitive domains tested. This protocol describes a systematic review and meta-analysis of paediatric TBI in the following key neurocognitive domains: executive function, perceptual–motor function, language, learning and memory, social cognition and complex attention.

Methods A comprehensive search comprising studies from Medline, Cochrane, Embase and PsycINFO published from 1988 to 2019 will be conducted. We will include studies on children ≤18 years old who suffer from mild, moderate and severe TBI as determined by the Glasgow Coma Scale that report neurocognitive outcomes in domains predetermined by the Diagnostic and Statistical Manual of Mental Disorders fifth edition criteria. Systematic reviews, meta-analyses, randomised controlled trials, case–control, cohort and cross-sectional studies will be included. References from systematic reviews and meta-analyses will be hand-searched for relevant articles. A meta-analysis will be performed and effect sizes will be calculated to summarise the magnitude of change in each neurocognitive domain compared at different timepoints and stratified by severity of TBI. Included studies will be pooled using pooled standardised mean differences with a random effects model to determine an overall effect. In the scenario that we are unable to pool the studies, we will perform a narrative analysis.

Ethics and dissemination Ethics approval is not required for this study.The authors of this study will publish and present the findings in a peer-reviewed journal as well as national and international conferences. The results of this study will provide understanding into the association between different severities of paediatric TBI and long-term neurocognitive outcomes.

PROSPERO registration number CRD42020152680.

  • child
  • brain injuries
  • cognitive disorders

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  • Contributors MSLG and S-LC coordinated the study. DSHL, MSLG and S-LC developed the search strategy and registered the protocol. DSHL drafted the manuscript. DSHL, JLG, MSLG, SSMG, RS, S-LC and JHL helped to inform the study design and revise the manuscript. MSLG obtained funding for the review. RS developed the meta-analytical strategy. All authors read and approved the final manuscript.

  • Funding This review is financially supported by Academic Medicine - Enhancing Training Healthcare Outcomes & Standards (ETHOS) Duke-NUS Medical Student Fellowship (AY2019-AY2020). Duke-NUS was not involved in the design of the protocol and analysis plan of the review, and will not provide input on the interpretation of the results.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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