Abstract
:Background:Traumatic Brain Injury (TBI) is the leading cause of mortality and morbidity especially in young ages. Despite over 30 years of using Neuroprotective agents for TBI management, there is no absolute recommended agent for the condition yet. Methods:This study is a part of a scoping review thesis on "Neuroprotective agents using for Traumatic Brain Injury: a systematic review & meta-analyses", which had a wide proposal keywords and ran in "Cochrane CENTRAL", "MedLine/PubMed", "SCOPUS", "Thomson Reuters Web of Science", "SID.ir", "Barket Foundation", and "clinicaltrials.gov" databases up to September 06, 2015. This study limits the retrieved search results only to those which used \\citicoline for TBI management. The included Randomized Clinical Trials’ (RCTs) were assessed for their quality of reporting by adapting CONSORT-checklist prior to extracting their data into meta-analysis. Meta-analyses of this review were conducted by Glasgow Outcome Scale (GOS) in acute TBI patients and total neuropsychological assessments in both acute and chronic TBI management, mortalities and adverse-effects. Results:Four RCTs were retrieved and included in this review with 1196 participants (10 were chronic TBI impaired patients); the analysis of 1128 patients for their favorable GOS outcomes in two studies showed no significant difference between the study groups; however, neuropsychological outcomes were significantly better in placebo/control group of 971 patients of three studies. Mortality rates and adverse-effects analysis based on two studies with 1429 patients showed no significant difference between the study groups. However, two other studies have neither mortality nor adverse effects reports due to their protocol. Conclusions:Citicoline use for acute TBI seems to have no field of support anymore, whereas it may have some benefits in improving the neuro-cognitive state in chronic TBI patients. It’s also recommended to keep in mind acute interventions like Psychological First Aid (PFA) during acute TBI management.
Highlights
Traumatic Brain Injury (TBI), known as Head Injury,[1,2,3] is the leading cause of mortality and morbidity[1,4,5,6] and mostly affects young people.[1]
“Neuroprotective agents using for traumatic brain injury: a systematic review & meta-analyses” whose search strategy was not restricted by date, race, gender, and publication status; date limitation to the reference databases (i.e. SCOPUS and Thomson Reuters Web of Science) was implemented for studies after 2000
Articles related to citicoline intervention use for TBI management were published from 1991 to 2014.11–14 Zafonete et al.'s study was a big multicentric study a.k.a COBRIT (Citicoline Brain Injury Treatment) and halted in its 4th interim analysis due to non-significant outcome differences between placebo and intervention groups, but patients followed up to 180 days after injury, the data for 180-day results are included in this metaanalysis
Summary
Traumatic Brain Injury (TBI), known as Head Injury,[1,2,3] is the leading cause of mortality and morbidity[1,4,5,6] and mostly affects young people.[1]. Adenosine Tri-Phosphate (ATP) is responsible for Cell Membrane Sodium-Potassium (Na-K) ATPase Pump’s Function. TBI related cell membrane un-integrity and accumulation of extracellular water lead to the brain edema and formation of lipid peroxidase. Cholinergic agents (e.g. Citicoline) have effects on cell-oxygenation cycles and formation of ATP, which may indirectly rebuild cell wall integrity, reducing further secondary injuries.[8]. Identification as a randomized trial in the title. Structured summary of trial design, methods, results, and conclusions (for specific guidance see CONSORT for abstracts). Specific objectives or hypotheses Reported on page No
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