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Posttraumatic Amnesia: A Systematic Review and Meta-Analysis. Proposal for a New Severity Classification.
Alexander R Vile1, Kevin Jang1, Dugald Gourlay1
1School of Medicine and Dentistry, James Cook University, Douglas, Townsville, Queensland, Australia.
World Neurosurgery
|March 15, 2022
Summary
Posttraumatic amnesia (PTA) duration reliably predicts outcomes after traumatic brain injury (TBI) when less than 7 days or greater than 42 days. However, PTA duration between 7 and 42 days is often unreliable for predicting TBI outcomes.
Area of Science:
- Neuroscience
- Neurology
- Traumatic Brain Injury Research
Background:
- Posttraumatic amnesia (PTA) duration is a key predictor of outcomes following traumatic brain injury (TBI).
- Existing literature lacks a comprehensive meta-analysis on the predictive accuracy of PTA duration for TBI outcomes.
Purpose of the Study:
- To systematically review and meta-analyze the predictive value of posttraumatic amnesia (PTA) duration for various outcomes after traumatic brain injury (TBI).
- To assess the sensitivity and specificity of different PTA duration cutoffs in predicting functional outcomes.
Main Methods:
- A systematic review and random-effects meta-analysis were conducted following PRISMA guidelines.
- Databases searched included Scopus, PubMed/MEDLINE, CINAHL, PsycINFO, and Embase.
- PTA's prediction of Glasgow Outcome Scale (GOS) and Extended (GOSE) scores was quantitatively assessed using pooled odds ratios and receiver operating characteristic curve analysis.
Main Results:
- Nine studies with 12,386 patients were included in the meta-analysis.
- PTA <7 days (mild TBI) demonstrated high sensitivity (87-90%) in excluding moderate/severe disability.
- PTA >42 days (severe TBI) showed high specificity (80-96%) in predicting moderate/severe disability, while PTA between 7-42 days had variable predictive accuracy.
Conclusions:
- PTA duration is a reliable predictor of TBI outcomes when <7 days or >42 days.
- The predictive accuracy of PTA duration is less reliable for moderate TBI (7-42 days).
- This meta-analysis provides quantitative evidence for PTA's prognostic value in TBI.
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