Updated - One Stop Evidence Guide for Brain Injury: Where to Search for Evidence Reviews

This guide has been developed to serve as a “one stop source” for evidence searches for acquired brain injury interventions.

Purpose

To develop a “one stop source” for evidence searches for acquired brain injury interventions. This listing directs individuals to existing data bases and systematic reviews.  This list is compiled by Sheila MacDonald M.Cl.Sc. SLP (C)* with assistance of Nathan Zasler, MD

Rationale

Although evidence based practice may be the intention of clinicians and researchers, the quest for appropriate systematic reviews within the field of ABI can be complex, time consuming and prohibitive for those who do not have library access.  The availability of a “one stop source for evidence” can promote multidisciplinary dialogue internationally, consistency, and efficiency of knowledge translation. The first step in creating evidence based clinical practice is to point end users to the best available evidence.

Format

This is a service of the International Brain Injury Association. It provides a brief listing of websites that present searchable data bases, ratings, summaries, abstracts, or full text of Systematic Reviews relevant to brain injury. The goal was to present websites that would be of assistance to all disciplines within the field of brain injury intervention.

Evidence Guide Selection Criteria

The primary intent of the One Stop Evidence Guide is to include those websites that meet the following selection criteria:

  1. Contain Systematic Reviews of studies relevant to ABI assessment and treatment
  2. Describe a  systematic methodology for evaluation, classification and rating of papers
  3. Possess an expert review process with reviewers who are regulated healthcare professionals
  4. Are free (exceptions were made when an equivalent free website could not be identified)

Members requested that websites containing Guidelines relevant to ABI also be included. The National Guidelines Clearing House website can direct readers to all available published guidelines. Therefore only this website has been provided under the Guidelines heading. There are numerous guidelines which vary in scope and rigour and only some are based on the conclusions of systematic reviews.  Websites leading to guidelines that are based on systematic reviews, and that meet the selection criteria, will be listed in the systematic review section of the evidence guide. Individual Articles are not listed.  Rather, websites that direct one to data bases of multiple articles are included. Finally we included a few general websites relevant to evidence based practice for the benefit of readers.

Where to Search for Guidelines

National Guideline Clearing House TM (NGC) www.guideline.gov

The NGC is a resource for evidence-based clinical practice guidelines. It is an initiative of the Agency for Healthcare Research Quality (AHRQ), U.S. Department of Health and Human Services and was originally created in partnership with the American Medical Association and the American Association of Health Plans.  It offers synthesesof selected guidelines that cover similar topic areas, and expert commentary on issues of interest and importance to the clinical guideline community. A search using the key words “brain injury” yielded 156 guidelines ranging on topics from acute care management of intracranial pressure to management of chronic pain.

Where to Search for Systematic Reviews

Open Access Sites to Search for Systematic Reviews Relevant to ABI 

Academy of Neurological Communication Disorders  (ANCDS)     
Provides full text of all published systematic reviews prepared by the ANCDS Evidence Based Practice Committee for Traumatic Brain Injury , as well as systematic reviews pertaining to Apraxia, Aphasia, Dysarthria, and Dementia. Reviews were conducted by expert panels of clinicians and researchers with expertise in neurological communication disorders.

American Academy of Neurology  (AAN) www.aan.com
AAN develops clinical practice guidelines to assist its members in clinical decision making related to the prevention, diagnosis, treatment, and prognosis of neurologic disorders. Each guideline makes specific practice recommendations based upon a rigorous and comprehensive evaluation of all available scientific data. A recent search under the key word “brain injury” yielded 6 guidelines specific to ABI, including topics such as brain death, coma, persistent vegetative state and management of concussion in sports.  There are additional guidelines on related topics (i.e. headache).

American Speech and Hearing Association (ASHA)Compendium of EBP Guidelines and Systematic Reviews
Prepared by ASHA's National Center for Evidence-Based Practice in Communication Disorders (N-CEP), it lists guidelines and reviews related to the fields of audiology and speech-language pathology. SR’s can be searched alphabetically and include a wide range of topics from acute care and Alzheimer’s disease to voice and written language. A search within the topic of brain injury yielded 23 SR’s relating to cognition, communication, and multidisciplinary assessment and treatment. The site also contains a list of international guidelines relevant to rehabilitation.

Brain Trauma Foundation  www.braintrauma.org
The Brain Trauma Foundation assembled groups of international experts in neurosurgery, surgery, pediatrics and EMS to prepare evidence based guidelines including: Guidelines for the Surgical management of Traumatic Brain Injury, Guidelines for the Management of Severe Traumatic Brain Injury, Guidelines for the Acute Medical management of Severe Traumatic Brain Injury of Infants, Children and Adolescents, and Early Indicators of Prognosis in Severe Traumatic Brain Injury. All guidelines may be viewed online or downloaded and hard copies can be ordered from the website.

Centre for Reviews and Dissemination CRD
The CRD is affiliated with the University of York, York, UK.,  and it provides 3 data bases described on the website as follows:  

  • DARE contains 15,000 abstracts of systematic reviews including over 6,000 quality assessed reviews and details of all Cochrane reviews and protocols.
  • NHS EED contains 24,000 abstracts of health economics papers including over 7,000 quality assessed economic evaluations.
  • HTA brings together details of over 8,000 completed and ongoing health technology assessments from around the world.

Searches on the DARE website provide lists of systematic reviews for brain injury published in peer reviewed journals as well as those conducted through the Cochrane Collaboration. At time of writing, a search of “Systematic Reviews of Brain Injury” yielded 95 SR’s on diverse subjects in medicine and rehabilitation.

Cochrane  Collaboration
Cochrane Database of Systematic Reviews
 – Provides a listing of systematic reviews conducted by the Cochrane Collaboration. Topics relate  to intervention, diagnostic test accuracy, and methodology on a wide range of healthcare topics. The research is reviewed using stringent guidelines with an emphasis on randomized controlled trials. Full text articles are available through the Cochrane Library which also has a bibliography of controlled trials called the Cochrane Central Register of Controlled Trials CCIR.

Evidence Updates 
Provided by BMJ Group and McMaster University's Health Information Research Unit

Provides a healthcare database that covers a wide range of medical topics from over 120 clinical journals. Studies are pre-rated for quality by research staff,  then rated for clinical relevance and interest by 3 members of a worldwide panel of practicing physicians.  Searches can be tailored to the user’s healthcare interests and email alerting is available. Registration is required.

Evidence Reviews for Acquired Brain Injury ERABI
Provides full text of systematic reviews of interventions for moderate to severe ABI that were produced by a Canadian project called Evidence Review for Acquired Brain Injury. Some of these reviews have been published in peer reviewed journals and others have not.

Global Evidence Mapping Initiative GEM
GEM maps the available research in traumatic brain injury and spinal cord injury. The GEM worked with the neurotrauma community to identify questions of high importance in pre-hospital, acute care, rehabilitation, and long term care. Searches conducted within these key areas (e.g. Behaviour, Community Integration etc.) include the 2009 ERABI systematic reviews and search forward to 2010 to produce an evidence report for each topic.  These maps will be regularly updated to reflect new published literature and there is a plan to expand the questions addressed over time. The GEM Initiative is funded by the Victorian Neurotrauma Initiative and based at the National Trauma Research Institute in Melbourne, Australia.

National Centre for Biotechnology Information; Pub Med, MedlineClinical Queries in Medline
Through the National Centre for Biotechnology Information’s website, it is possible to conduct searches of systematic reviews in all journals indexed with PubMed, save these searches, access the abstracts, and sign up for email alerting of new publications that meet the search criteria. On the  NCBI website users can access  “My NCBI” in the upper right hand corner to register for these free services. PubMed comprises more than 19 million citations for biomedical literature from MEDLINE, life science journals, and online books. These searches usually do not include full text articles.

OT Seeker 
Developed by a team of occupational therapists from two Australian Universities, with involvement from OT’s in Canada and the UK. Contains abstracts of systematic reviews and randomized controlled trials relevant to occupational therapy. Trials have been critically appraised and rated to help users evaluate their validity and interpretability.

PsycBITE
An open access data base of systematic reviews, and individual studies of cognitive, behavioural and other treatments for psychological problems occurring as a consequence of ABI. All studies are evaluated systematically by expert reviewers.  Searches can be tailored according to age group, diagnosis, and type of intervention. Searches can be saved for future reference. 

Physiotherapy Evidence Database
An open access database of over 16,000 abstracts of randomized trials, systematic reviews and clinical practice guidelines in physiotherapy. Most trials on the database have been rated for quality.

SpeechBITE 
An open access data base that provides evaluation, categorization, and search capabilities for systematic reviews and individual studies relevant to speech-language pathologists and others interested in communication. Searches can be tailored according to population, communication disorder, and intervention characteristics

Restricted Access Data Bases

ACP Journal Club
Produced by the American College of Physicians, this website comprises a 10 year archive (from 2000 to the present) of the cumulative electronic contents of ACP Journal Club.  The content is selected from over 100 clinical journals through reliable application of explicit criteria for scientific merit and relevance to medical practice by clinical specialists.. The result is an enhanced abstract of the chosen article and a commentary on its value for clinical practice.

ACP PIER Please check URL- this one is correct. http://pier.acponline.org/index.html
The Physician’s Information and Education Resource (PIER) is produced by the American College of Physicians. It is an evidence-based collection of disease modules can be searched, or browsed alphabetically or by organ system on Stat!Ref. It also contains the AHFS Drug Information Essentials.

BMJ Clinical Evidence
This is a database produced by BMJ Publishing Group. It costs $285.00 US dollars per year (Discounts for members, nurses, students). It searches the world literature for the best available evidence from systematic reviews, RCT’s, and observational studies where appropriate and produces its own systematic reviews on the benefits and harms of clinical interventions. Each systematic review contains a page that lists key clinical questions and interventions and describes whether they have been effective or not. Interventions are rated according to the following categories: beneficial, likely to be beneficial, trade off between benefits and harms, unknown effectiveness, unlikely to be beneficial, and likely to be harmful or unbeneficial.

DynaMed 
This is aclinical reference tool created by physicians for physicians and other health care professionals for use primarily at the 'point-of-care'.  Individual and institutional subscriptions are available at an “affordable price” and the company can be contacted for quotes. It offers clinically organized summaries on more than 3000 topics. It is updated daily and monitors the content of over 500 medical journals and systematic evidence review databases directly and indirectly by using many journal review services. Each publication is reviewed cover-to-cover, and each article is evaluated for clinical relevance and scientific validity. The new evidence is then integrated with existing content, and overall conclusions are changed as appropriate representing a synthesis of the best available evidence.

General Resources for Health Information and Evidence Based Medicine

The following resources provide general health information and information relating to evidence based practice. They  are not designed with the purpose of searching for systematic reviews relevant to brain injury

Agency for Health Care research
Under the Evidence-based Practice Centers (EPC) Program of the Agency for Healthcare Research and Quality (formerly the Agency for Health Care Policy and Research—AHCPR), 5-year contracts are awarded to institutions in the United States and Canada to serve as EPCs. The EPCs review all relevant scientific literature on clinical, behavioral, and organization and financing topics to produce evidence reports and technology assessments. These reports are used for informing and developing decisions, quality measures, educational materials, tools, guidelines, and research agendas. The EPCs also conduct research on methodology of systematic reviews.

Centre for Evidence Based Medicine
Developed by the Centre for Evidence-Based Medicine in Oxford in the UK. The Centre promotes evidence-based health care and provides support and resources to anyone who wants to make use of them. Includes theEBM Toolbox, an assortment of materials which are very useful for practitioners of EBM, and EBM Teaching Materials, including PowerPoint presentations.

CEBM Toronto
Includes many resources for practicing and teaching EBM.  The goal of this website is to help develop, disseminate, and evaluate resources that can be used to practice and teach EBM for undergraduate, postgraduate and continuing education for health care professionals from a variety of clinical disciplines.

Duke University Library EBM
A list of  EBM websites developed and maintained by Duke University Medical Center Library.

Health Insite
Topics/Systematic Reviews of Treatments for Brain Injuries
An initiative of the government of Australia, HealthInsite aims to provide quality information on a wide range of health topics. Information in the data base is gathered from websites of information partners who meet established quality criteria.  For example, systematic reviews may be gathered from the Cochrane Collaboration or similar sites from “leading health information providers”.

Netting the Evidence 
Accessed through google. Type in “netting the evidence”
This is a search engine dedicated to the methodology of evidence based practice from the School of Health and Related Research (ScHARR) at the University of Sheffield, UK. Includes a comprehensive list of EBM databases, journals, articles, and other information sources. It searches sites including:http://www.york.ac.uk/inst/crd/http://www.sbu.se/http://hiru.mcmaster.ca/hiru/http://www.cebm.net/,http://www.cche.net/
A search of  “brain injury systematic reviews”  yielded a list of 92 studies on a wide variety of topics from acute care management to prognostic factors, to use of  hypobaric oxygen chambers and interventions for MTBI.

NHS Economic Evaluation Database
Funded by the Departments of Health of England and Wales to assist decision-makers by systematically identifying and describing economic evaluations, appraising their quality and highlighting their relative strengths and weaknesses. Contains over 6000 abstracts of quality- assessed economic evaluations.

TRIP Database 
TRIP Database is an open access resource for clinicians designed to answer specific questions posed. It searches a wide variety of sources. Results yield a combination of systematic reviews, individual studies, reports, and online documents from sources which are not all publications in peer reviewed journals..  At time of writing, a search for ABI or TBI systematic reviews yielded 20 results including summaries of studies as diverse as autism and hemodialysis. The first 11 websites in the table yield more consistent results for ABI systematic reviews.  

*Sheila MacDonald& Associates, Suite 26, 5420 Hwy 6 North, Guelph, Ont. Canada. N1H 6J2