Abstract
BackgroundOur understanding of recovery after moderate-to-severe traumatic brain injury (TBI) has shifted. Until recently, it was presumed that following a period of acute neurological vulnerability, the brain remained stable in the chronic stages of injury. However, recent research has shown neurodegeneration in the chronic stages of moderate-to-severe TBI, challenging the assumption of neurological stability. While there is extensive evidence that neurodegeneration occurs, debate remains regarding the scale and timing. This systematic review will evaluate the scale and timelines of neurodegeneration in adult patients with moderate-to-severe TBI.MethodsLiterature searches will be conducted in six electronic databases (from inception onwards), including MEDLINE, EMBASE, PsycINFO, CINAHL, SportDiscus, and Cochrane Central Register of Controlled Trials. We will include observational studies that examine neurodegenerative changes within a single sample of TBI patients or studies that compare neuroimaging outcomes between TBI patients and healthy controls. Our primary outcome is structural neuroimaging, and our secondary outcome is diffusion tensor imaging for detection of post-injury white matter changes. All screening, data extraction, and study quality appraisal will be performed independently by the same two study members. It is expected that a narrative summary of the literature will be produced. If feasible, we will conduct a random-effects meta-analysis. However, given the expected heterogeneity between studies (with respect to, for example, timing of imaging, regions imaged) we do not expect to perform a meta-analysis; rather, a narrative synthesis of our findings is expected to be performed.DiscussionUnderstanding the scale and timelines of neurodegeneration in moderate-to-severe TBI (as well as which brain areas are most vulnerable to chronic declines) can inform intervention research designed to offset such changes. This may help improve patient outcome following moderate-to-severe TBI and, in turn, reduce the burden of the injury.Systematic review registrationPROSPERO CRD42019117548
Highlights
Our understanding of recovery after moderate-to-severe traumatic brain injury (TBI) has shifted
More than 1% of the general population is estimated to be living with disability secondary to TBI [29] and TBI is projected to become the third-most cause of disability by the year 2020 [1]
Recent studies have challenged this notion, and there is a compelling evidence base that suggests that TBI is neurodegenerative [2, 4, 6, 9, 16, Sharma et al Systematic Reviews (2019) 8:332
Summary
Our understanding of recovery after moderate-to-severe traumatic brain injury (TBI) has shifted. It was presumed that following a period of acute neurological vulnerability, the brain remained stable in the chronic stages of injury. Recent research has shown neurodegeneration in the chronic stages of moderate-to-severe TBI, challenging the assumption of neurological stability. This systematic review will evaluate the scale and timelines of neurodegeneration in adult patients with moderate-to-severe TBI. Moderate-to-severe traumatic brain injury (TBI) is a leading public health concern [12, 13]. Neurological stability in the sub-acute and chronic stages of moderate-to-severe TBI was presumed. Recent studies have challenged this notion, and there is a compelling evidence base that suggests that TBI is neurodegenerative [2, 4, 6, 9, 16, Sharma et al Systematic Reviews (2019) 8:332
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