Methodological quality of systematic reviews addressing therapeutic hypothermia and/or cooling therapy for traumatic brain injury

DOI: 10.15343/0104-7809.201943049961015

Abstract

Therapeutic hypothermia and/or cooling therapy are suggested to have benefits in patients with acute traumatic brain injury, and several systematic reviews (SRs) have been performed to synthesize the evidence from randomized clinical trials (RCTs). The objective of this critical appraisal study was to assess the methodological quality of SRs that evaluated the use of therapeutic hypothermia and/or cooling therapy in patients with acute traumatic brain injury. A broad and sensitive search of the literature was performed in March 2019. Four major electronic databases (MEDLINE, EMBASE, LILACS and Cochrane Library) were considered. The study selection, data extraction and the appraisal of the methodological quality was carried out by two independent reviewers. The methodological quality of the included SRs was assessed using the AMSTAR-2 (A MeaSurement Tool to Assess systematic Reviews) tool. The search strategy retrieved 149 articles, and 16 SRs were included after the selection process. They were published between 2003 and 2018, and the number of included clinical trials varied from 0 to 37. The overall confidence in the results from included SRs was graded as critically low in 53.3%, low in 13.3%, moderate in 20%, high in 13.3%. In Conclusion, most of the included SRs had poor methodological quality and only two systematic reviews were judged as having high overall confidence in the results in accordance to AMSTAR-2. Decision makers should consider the overall quality of the synthesis when using or recommending hypothermia and/or cooling therapy for practice.