Background: Traumatic brain injury (TBI) has been estimated to affect 1.7 to 10 million people annually in the general United States population. TBI may occur less frequently in the workplace compared to other injuries, but it carries enormous per capita costs, in large part due to vocational issues of impairments, employability and productivity. It is estimated that the average lifetime cost of a TBI patient ranges from $600,000 to $1,875,000.
Objectives: To develop a TBI treatment guideline that provides evidence-based guidance on the treatment of working-age adults who have sustained TBI.
Methods: A comprehensive, systematic literature search was conducted using PubMed, Scopus, CINAHL, Google Scholar and the Cochrane Library. Randomised-controlled trials (RCTs), randomised-crossover trials, quality guidelines, meta-analyses and systematic reviews were the primary foci of these exhaustive literature searches. A quantitative scoring method was used to evaluate the quality of each RCT. A study is considered low quality if the composite rating was 3.5 or less, moderate quality if rated 4-7.5, and high quality if rated 8-11. This system results in a testable article score and more reproducible guidelines methods.
Results: A total of 146 PICO questions were addressed for the treatment of TBI. Our searches identified 437 RCTs of which 30 were high quality, 297 were moderate quality, and 110 were low quality. Recommended treatments for TBI include suicide prevention, attention-regulation training, occupational rehabilitation, cognitive behavioural therapies and oxygen monitoring and thresholds (Evidence C). Anger-management therapy, motivational interviewing and emotional training are recommended with insufficient evidence.
Conclusions: These guidelines provide more informed recommendations for the treatment of TBI with details to be presented.They may have considerable implications for health professionals.