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Abstract
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INTRODUCTION: 'Post Traumatic Amnesia' ('PTA') duration is used to predict outcome after traumatic brain injury (TBI): however, no meta-analysis exists.
METHODS: Systematic review following PRISMA reporting guidelines. Databases Scopus-1966, PubMed/MEDLINE, CINAHL, PSYCHINFO and EMBASE were searched for relevant texts. Random-effects meta-analysis derived pooled estimates of the odds ratio of outcomes of interest and sensitivity and specificity of 'PTA' at different cut-offs, and subsequently a summary receiver operating curve (SROC) was derived. MAIN OUTCOMES AND MEASURES: 'PTA' prediction of Glasgow Outcome Scale (GOS) and Glasgow Outcome Scale Extended (GOSE) scores was assessed both qualitatively and quantitatively by pooled odds ratio regarding both a 'good' outcome ('GO': GOS-5 or GOSE-7/GOSE-8) and a 'severe' disability outcome ('SDO': GOS-3 or a GOSE-3/GOSE-4). SROC analysis was performed in the prediction of composite of a 'moderate' disability outcome ('MDO': GOS-4 or GOSE-5/GOSE-6) and SDO.
RESULTS: Twenty-four studies were included in qualitative synthesis, and nine (12,386 patients, males 64-84%) in meta-analysis. The odds of a GO and SDO were significantly different between 'PTA'>56 days and 'PTA'<7 days (P=0.04 and P=0.03). 'PTA'<7 days ('mild' TBI) excluded MDO/SDO and SDO alone with 87% and 90% sensitivity. 'PTA' of 43-86 days ('severe' TBI) predicted MDO/SDO or SDO with 90-96% and 80-90% specificity. However, 'PTA' of 7-42 days ('moderate' TBI) predicted MDO/SDO or SDO with only 38-89% and 30-80% specificity.
CONCLUSION: 'PTA' duration was reliable in predicting outcome when less than 7 days, and especially when greater than 42 days; but was often unreliable between 7-42 days' duration.
Language: en |