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Open Access Protocol

Incidence, prevalence, and occurrence rate of infection among adults hospitalized after traumatic brain injury: study protocol for a systematic review and meta-analysis

Brittney NV Scott12, Derek J Roberts134, Helen Lee Robertson5, Andreas H Kramer167, Kevin B Laupland1389, Shalina S Ousman1067, Paul Kubes1112 and David A Zygun1122*

Author Affiliations

1 Department of Critical Care Medicine, University of Calgary and the Foothills Medical Centre, 3134 Hospital Drive NW, Calgary, Alberta T2N 5A1, Canada

2 Calvin, Phoebe, and Joan Snyder Institute for Chronic Diseases, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada

3 Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada

4 Department of Surgery, University of Calgary and the Foothills Medical Centre, 1403 29th Street NW, Calgary, Alberta T2N 2T9, Canada

5 Health Sciences Library, University of Calgary, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada

6 Department of Clinical Neurosciences, University of Calgary and the Foothills Medical Centre, 1403 29th Street NW, Calgary, Alberta T2N 2T9, Canada

7 Hotchkiss Brain Institute, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada

8 Department of Medicine, University of Calgary and the Foothills Medical Centre, 1403 29th Street NW, Calgary, Alberta T2N 2T9, Canada

9 Intensive Care Unit, Royal Inland Hospital, 311 Columbia Street, Kamloops, British Columbia V2C 2T1, Canada

10 Department of Cell Biology and Anatomy, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada

11 Department of Physiology and Pharmacology, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada

12 Division of Critical Care Medicine, University of Alberta and the University of Alberta Hospital, 8440 - 112 Street, Edmonton, Alberta T6G 2B7, Canada

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Systematic Reviews 2013, 2:68  doi:10.1186/2046-4053-2-68

Published: 24 August 2013

Abstract

Background

Infection occurs commonly among patients hospitalized after traumatic brain injury (TBI) and has been associated with increased intensive care unit and hospital lengths of stay and an elevated risk of poor neurological outcome and mortality. However, as many relevant published studies to date have varied in the type and severity of TBI among included patients as well as in their design (randomized versus non-randomized), risk of bias, and setting (hospital ward versus intensive care unit), their reported estimates of infection occurrence vary considerably. Thus, the purpose of this systematic review and meta-analysis is to estimate the incidence, prevalence, and occurrence rate of infection among patients hospitalized after TBI.

Methods/Design

We will search electronic bibliographic databases (MEDLINE, EMBASE, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Cochrane Database of Systematic Reviews) from their first available date as well as personal files, reference lists of included articles, and conference proceedings. Two investigators will independently screen titles and abstracts and select cohort studies, cross-sectional studies, and randomized controlled trials involving adults hospitalized after TBI that reported estimates of cumulative incidence, incidence rate, prevalence, or occurrence rate of infection for inclusion in the systematic review. These investigators will also independently extract data and assess risk of bias. We will exclude studies with fewer than ten patients; experimental groups allocated to treatment with antibiotics, glucocorticoids, immunosuppressants, barbiturates, or hypothermia; and studies focused on military/combat-related TBI. Pooled estimates of cumulative incidence, incidence rate, prevalence, and occurrence rate will be calculated using random effects models. We will also calculate I2 and Cochran Q statistics to assess for inter-study heterogeneity and conduct stratified analyses and univariate meta-regression to determine the influence of pre-defined study-level covariates on our pooled estimates.

Discussion

This study will compile the world literature regarding the epidemiology of infection among adults hospitalized after TBI. A better understanding of the role of infection will be helpful in the development of guidelines for patient management. This protocol has been registered in the PROSPERO International Prospective Register of Systematic Reviews (ID: CRD42013005146).

Keywords:
Craniocerebral trauma; Infection; Incidence; Prevalence; Systematic review; Meta-analysis