Pharmacological interventions for agitation in patients with traumatic brain injury: protocol for a systematic review and meta-analysis View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2016-11-17

AUTHORS

David R. Williamson, Anne Julie Frenette, Lisa Burry, Marc M. Perreault, Emmanuel Charbonney, François Lamontagne, Marie-Julie Potvin, Jean-François Giguère, Sangeeta Mehta, Francis Bernard

ABSTRACT

BackgroundTraumatic brain injury (TBI) is a worldwide leading cause of mortality and disability. Among TBI complications, agitation is a frequent behavioural problem. Agitation causes potential harm to patients and caregivers, interferes with treatments, leads to unnecessary chemical and physical restraints, increases hospital length of stay, delays rehabilitation, and impedes functional independence. Pharmacological treatments are often considered for agitation management following TBI. Several types of agents have been proposed for the treatment of agitation. However, the benefit and safety of these agents in TBI patients as well as their differential effects and interactions are uncertain. In addition, animal studies and observational studies have suggested impaired cognitive function with the use of certain antipsychotics and benzodiazepines. Hence, a safe and effective treatment for agitation, which does not interfere with neurological recovery, remains to be identified.Methods/designWith the help of Health Sciences librarian, we will design a search strategy in the following databases: PubMed, Ovid MEDLINE®, EMBASE, CINAHL, PsycINFO, Cochrane Library, Google Scholar, Directory of Open Access Journals, LILACS, Web of Science, and Prospero. A grey literature search will be performed using the resources suggested in CADTH’s Grey Matters. We will include all randomized controlled, quasi-experimental, and observational studies with control groups. The population of interest is all patients, including children and adults, who have suffered a TBI. We will include studies in which agitation, not further defined, was the presenting symptom or one of the presenting symptoms. We will also include studies where agitation was not the presenting symptom but was measured as an outcome variable and studies assessing the safety of these pharmacological interventions in TBI patients. We will include studies evaluating all pharmacological interventions including beta-adrenergic blockers, typical and atypical antipsychotics, anticonvulsants, dopamine agonists, psychostimulants, antidepressants, alpha-2-adrenergic agonists, hypnotics, and anxiolytics.DiscussionAlthough agitation is frequent following TBI and pharmacological agents that are often used, there is no consensus on the most efficacious and safest strategy to treat these complications. There is a need for an updated systematic review to summarize the evidence in order to inform practice and future research.Systematic review registrationPROSPERO CRD42016033140 More... »

PAGES

193

Journal

TITLE

Systematic Reviews

ISSUE

1

VOLUME

5

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s13643-016-0374-6

DOI

http://dx.doi.org/10.1186/s13643-016-0374-6

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1019967372

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/27855720


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28 schema:description BackgroundTraumatic brain injury (TBI) is a worldwide leading cause of mortality and disability. Among TBI complications, agitation is a frequent behavioural problem. Agitation causes potential harm to patients and caregivers, interferes with treatments, leads to unnecessary chemical and physical restraints, increases hospital length of stay, delays rehabilitation, and impedes functional independence. Pharmacological treatments are often considered for agitation management following TBI. Several types of agents have been proposed for the treatment of agitation. However, the benefit and safety of these agents in TBI patients as well as their differential effects and interactions are uncertain. In addition, animal studies and observational studies have suggested impaired cognitive function with the use of certain antipsychotics and benzodiazepines. Hence, a safe and effective treatment for agitation, which does not interfere with neurological recovery, remains to be identified.Methods/designWith the help of Health Sciences librarian, we will design a search strategy in the following databases: PubMed, Ovid MEDLINE®, EMBASE, CINAHL, PsycINFO, Cochrane Library, Google Scholar, Directory of Open Access Journals, LILACS, Web of Science, and Prospero. A grey literature search will be performed using the resources suggested in CADTH’s Grey Matters. We will include all randomized controlled, quasi-experimental, and observational studies with control groups. The population of interest is all patients, including children and adults, who have suffered a TBI. We will include studies in which agitation, not further defined, was the presenting symptom or one of the presenting symptoms. We will also include studies where agitation was not the presenting symptom but was measured as an outcome variable and studies assessing the safety of these pharmacological interventions in TBI patients. We will include studies evaluating all pharmacological interventions including beta-adrenergic blockers, typical and atypical antipsychotics, anticonvulsants, dopamine agonists, psychostimulants, antidepressants, alpha-2-adrenergic agonists, hypnotics, and anxiolytics.DiscussionAlthough agitation is frequent following TBI and pharmacological agents that are often used, there is no consensus on the most efficacious and safest strategy to treat these complications. There is a need for an updated systematic review to summarize the evidence in order to inform practice and future research.Systematic review registrationPROSPERO CRD42016033140
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35 CINAHL
36 Cochrane Library
37 EMBASE
38 Google Scholar
39 LILACS
40 MEDLINE
41 Ovid MEDLINE
42 PROSPERO
43 PsycINFO
44 PubMed
45 TBI
46 TBI complications
47 TBI patients
48 Web
49 Web of Science
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51 addition
52 adults
53 agents
54 agitation
55 agitation management
56 agonists
57 alpha-2 adrenergic agonists
58 animal studies
59 anticonvulsants
60 antidepressants
61 antipsychotics
62 anxiolytics
63 atypical antipsychotics
64 behavioral problems
65 benefits
66 benzodiazepines
67 beta-adrenergic blockers
68 blockers
69 brain injury
70 caregivers
71 cause
72 certain antipsychotics
73 chemicals
74 children
75 cognitive function
76 complications
77 consensus
78 control group
79 database
80 delay rehabilitation
81 differential effects
82 directory
83 disability
84 dopamine agonists
85 effect
86 effective treatment
87 evidence
88 frequent behavioral problems
89 function
90 functional independence
91 future research
92 gray matter
93 grey literature search
94 group
95 harm
96 health sciences librarians
97 help
98 hospital length
99 hypnotics
100 independence
101 injury
102 interaction
103 interest
104 intervention
105 journals
106 leading cause
107 length
108 librarians
109 library
110 literature search
111 management
112 matter
113 mortality
114 need
115 neurological recovery
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119 outcome variables
120 patients
121 pharmacological agents
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123 pharmacological treatment
124 physical restraint
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129 presenting symptom
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134 research
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143 search
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145 stay
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147 study
148 symptoms
149 systematic review
150 traumatic brain injury
151 treatment
152 treatment of agitation
153 types
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155 unnecessary chemicals
156 use
157 variables
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