PICOS for each clinical practice
| # | Clinical practice |
| Mild traumatic brain injury | |
| 1 | Population: adults with acute mild traumatic brain injury Intervention: validated clinical decision rule (eg, CCHR, CHIP, NEXUS II, NOC) Comparator: none Primary outcome: false negative rate (intracranial injury, neurosurgical intervention) Secondary outcomes: sensitivity, specificity Study design: systematic review |
| 2 | Population: adults with acute mild complicated traumatic brain injury Intervention: routine repeat head CT in absence of neurological deterioration Comparator: none or no repeat head CT in absence of neurological deterioration Primary outcome: progression of intracranial injury Secondary outcomes: neurosurgical intervention, mortality, change in management, hospital length of stay Study design: systematic review |
| 3 | Population: adults with acute mild traumatic brain injury and on anticoagulant and/or antiplatelet therapy Intervention: routine repeat head CT in absence of neurological deterioration Comparator: none or no repeat head CT in absence of neurological deterioration Primary outcome: progression of intracranial injury Secondary outcomes: neurosurgical intervention, mortality, change in management, hospital length of stay Study design: systematic review |
| 4 | Population: adults with acute mild traumatic brain injury who are negative on head CT Intervention: neurosurgical consultation Comparator: none or no neurosurgical consultation Primary outcome: hospital admission Secondary outcomes: neurosurgical intervention, mortality, ICU admission, repeat head CT, hospital length of stay Study design: systematic review |
| 5 | Population: adults with acute mild complicated traumatic brain injury who are not on irreversible anticoagulation Intervention: intensive care unit admission Comparator: admission to regular ward or step-down unit Primary outcome: neurological/medical decline, neurosurgical intervention Secondary outcomes: medical interventions, mortality, adverse events, hospital length of stay, discharge destination Study design: systematic review |
| Moderate and severe traumatic brain injury | |
| 6 | Population: adults with acute traumatic brain injury on antiplatelet therapy Intervention: platelet transfusion Comparator: no platelet transfusion Primary outcome: GOS or GOS-E Secondary outcomes: mortality, adverse events, hospital and ICU length of stay Study design: systematic review |
| 7 | Population: adults with basal skull fractures without evidence of cerebrospinal fluid leakage Intervention: antibiotic prophylaxis Comparator: no antibiotic prophylaxis Primary outcome: meningitis (confirmed by lumbar puncture) Secondary outcomes: GOS or GOS-E, mortality, surgical correction in patients with CSF leakage, non-CNS infection, hospital and ICU length of stay Study design: systematic review |
| 8 | Population: adults with acute traumatic brain injury and no refractory intracranial hypertension Intervention: therapeutic hypothermia Comparator: no therapeutic hypothermia Primary outcome: GOS or GOS-E Secondary outcomes: intracranial pressure, mortality, adverse events, hospital and ICU length of stay Study design: systematic review |
| 9 | Population: adults with acute traumatic brain injury Intervention: antibiotic prophylaxis for external ventricular drain placement Comparator: no antibiotic prophylaxis Primary outcome: ventriculostomy-related infection Secondary outcomes: GOS, mortality, hospital and ICU length of stay Study design: systematic review |
| 10 | Population: adults with acute traumatic brain injury and no refractory intracranial hypertension Intervention: neuromuscular blocking agents Comparator: no neuromuscular blocking agents Primary outcome: GOS or GOS-E Secondary outcomes: intracranial pressure, mortality, adverse events, hospital and ICU length of stay Study design: systematic review |
| 11 | Population: adults with acute traumatic brain injury Intervention: plasma transfusion Comparator: no plasma transfusion Primary outcome: GOS or GOS-E Secondary outcomes: mortality, adverse events, hospital and ICU length of stay Study design: systematic review |
| Severe traumatic brain injury | |
| 12 | Population: adults with acute severe traumatic brain injury Intervention: albumin Comparator: any other colloid-containing fluids (dextrans, modified gelatins, hydroxyethyl starches) or isotonic crystalloid fluids (saline 0.9% and balanced salt solutions such as compound sodium lactate, Plasma-Lyte) Primary outcome: GOS or GOS-E Secondary outcomes: mortality, adverse events, hospital and ICU length of stay Study design: systematic review |
| 13 | Population: adults with acute severe traumatic brain injury Intervention: antiseizure prophylaxis (levetiracetam or phenytoin)>1 week Comparator: antiseizure prophylaxis <1 week or no antiseizure prophylaxis Primary outcome: late post-traumatic seizure Secondary outcomes: GOS or GOS-E, mortality, adverse events, hospital and ICU length of stay Study design: systematic review |
CCHR, Canadian Computed Tomography Head Rule; CHIP, CT in head injury patients; CNS, central nervous system; CSF, cerebrospinal fluid; GOS, Glasgow Outcome Scale; GOS-E, Glasgow Outcome Scale-Extended; ICU, intensive care unit; NEXUS, National Emergency X-Radiography Utilisation Study; NOC, New Orleans Criteria; PICOS, population, intervention, comparator, outcome and study design.