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Information about ongoing health services research and public health projects
| Prevalence of and interventions for sleep wake disturbances in children following critical care for traumatic brain injury: a systematic review | |
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| Investigator (PI): | Williams, Cydni; Luther, Maddie; Lim, Miranda; Eriksson, Carl |
| Performing Organization (PO): |
(Current): Oregon Health and Science University, School of Medicine, Department of Pediatrics / (503) 494-8811 |
| Supporting Agency (SA): | Agency for Healthcare Research and Quality (AHRQ) |
| Initial Year: | 2018 |
| Final Year: | 2019 |
| Record Source/Award ID: | PROSPERO/CRD42018115619 |
| Award Type: | Contract |
| Abstract: | Review question: 1. What is the prevalence and characterization of sleep wake disturbances (SWD) following pediatric neurocritical care for traumatic brain injury (TBI)? 2. What interventions have been studied to treat various SWD seen in survivors of childhood TBI and what is the effectiveness for improving SWD? 3. What global health outcomes (post-intensive care syndrome) are associated with SWD and interventions for SWD? Searches: Data sources will be systematically searched, including MEDLINE and Cochrane Central Register of Controlled Trials. Search terms for population and interventions will be combined and searches limited to English, all children 0-18 years, and humans. Manual searches of reference lists from included articles and searches of articles citing included articles through Scopus will also be conducted. Types of study to be included: We will include randomized controlled trials (RCTs), non-randomized trials, including time series, prospective and retrospective cohort studies, case-control studies, and case series. Condition or domain being studied: The main objectives of this review are to quantify sleep wake disturbances (SWD) after pediatric traumatic brain injury requiring neurocritical care, identify interventions available for SWD, and determine effectiveness of these interventions in children after traumatic brain injury (TBI). Participants/population: We will evaluate children 18 years and younger who survive TBI, excluding patients with concussion (mild TBI without documented skull fracture or intracranial pathology). Intervention(s), exposure(s): We will evaluate pharmacologic therapies (melatonin, stimulants for fatigue, clonidine, antihistamines, Lunesta/eszopiclone, Ambien/zolpidem, etc.). We will evaluate non-pharmacological interventions, including cognitive behavioral intervention, behavioral and environmental interventions, light therapy, dietary interventions, and educational interventions. Comparator(s)/control: These are no intervention, placebo, other therapies or interventions. Context: The context is post-discharge from hospitalization for neurocritical care with traumatic brain injury in developed countries. Main outcome(s): The main outcomes are improvement in SWD as measured by child- or parent-reported sleep and fatigue questionnaires and objective measures of sleep such as actigraphy. Additional outcome(s): Additional outcomes are quality of life measures, neurocognitive measures, psychological assessments, behavior, acceptability and feasibility of interventions, satisfaction with interventions, and adverse events, including medication side effects. Quantitative and qualitative data will be included for secondary outcomes. Data extraction (selection and coding): Two independent members screen all titles and abstracts identified in search for inclusion criteria; two reviewers will then read the full text of articles identified in screening. We will seek additional information from study authors where necessary to resolve questions about eligibility. We will resolve disagreement through discussion. We will record the reasons for excluding studies. Neither of the review authors will be blind to the journal titles or to the study authors or institutions. Included/excluded articles will be compared for consistency between authors and disputes resolved through discussion; PICOTS (populations, interventions, comparators, outcomes, timings, settings) criteria, study design, and language (as described above) will be used to code exclusions 1-8. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram will be created for reporting results of study selection. Data collection process: Two reviewers will abstract data to a Microsoft Excel spreadsheet. Data abstracted will include demographic information, methodology, intervention details, and all reported health outcomes. Reviewers will resolve disagreements by discussion. We will contact study authors to resolve any uncertainties. Risk of bias (quality) assessment: We will assess quality of RCTs using the Cochrane Risk of Bias Tool. We will assess quality of observational studies using the STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) and CONSORT (Consolidated Standards of Reporting Trials) tools. Two authors will assess risk of bias for individual studies. Reviewers will resolve disagreements by discussion. After determining risk of bias for individual studies, we will summarize the risk of bias for each outcome as "low risk," "high risk," or "unclear risk." Strategy for data synthesis: If studies are sufficiently homogeneous in terms of design and outcomes, we will conduct meta-analyses for each outcome and or intervention. For dichotomous outcomes, we will measure effects with risk ratio, risk difference, or odds ratio (depending on data available from included studies; we will use risk ratio if possible) with 95% confidence interval. For continuous outcomes, we will use weighted mean differences with 95% confidence intervals (we will use standardized mean differences if different measurement scales are used). Qualitative outcomes will be extracted and assessed via thematic analysis by two team members. Analysis of subgroups or subsets: If necessary data are available, subgroup analyses will be done for severity of TBI (mild, moderate, severe) based on standard Glasgow Coma Scale score grouping. |
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| Country: | United States |
| State: | Oregon |
| Zip Code: | 97239 |
| UI: | 20192143 |
| Project Status: | Completed |
| Record History: | ('Dr. Williams is supported by grant number K12HS022981 from the Agency for Healthcare Research and Quality.',) |
