BACKGROUND Traumatic brain injury (TBI) is a leading cause of death and disability. Recently, a paradigm shift in our understanding of moderate-to-severe TBI has led to its reconceptualization as a progressive neurodegenerative disorder. Widespread progressive atrophy is observed in the months and years post-injury, long after the acute effects of the injury have resolved. Some studies have begun to examine prognostic demographic, injury-related, and post-injury risk factors that contribute to these declines. A synthesis of this information, and in particular, an increased understanding of post-injury factors that may be modifiable, would improve our ability to design interventions to reduce neurodegeneration in moderate-to-severe TBI. This systematic review aims to identify prognostic factors for neural deterioration in moderate-to-severe TBI, and thereby inform future intervention research in this population. METHODS This review protocol was informed by and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) guidelines. Search strategies (designed to identify literature on prognostic factors of neurodegeneration in adults with moderate-to-severe TBI) optimized for MEDLINE, EMBASE PsychINFO, CINAHL, SportDiscus, and Cochrane Central Register of Controlled Trials will be developed with the assistance of a health sciences librarian. Retrieved studies will be screened by two team members. Studies must report on longitudinal neuroimaging (i.e., two or more scans in the same cohort) or neuroimaging in a cross-sectional study and potential prognostic factors for neurodegeneration, such as demographics (e.g., gender, age, education), injury (e.g., severity, etiology), or post-injury characteristics (e.g., type and length of therapy, activity level, mood). DISCUSSION By identifying prognostic factors for neurodegeneration, this systematic review can help inform injury management, as well as intervention research designed to offset the effects of modifiable prognostic factors, such as low levels of cognitive or physical activity. In turn, this systematic review can increase our understanding of how to improve outcome following moderate-to-severe TBI. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019122389.

中文翻译：

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慢性中度至重度创伤性脑损伤神经退行性变的预后因素：系统评价方案。

背景技术创伤性脑损伤(TBI)是死亡和残疾的主要原因。最近，我们对中度至重度 TBI 的理解发生了范式转变，导致其被重新概念化为一种进行性神经退行性疾病。在损伤后的数月和数年中，​​即损伤的急性影响消失很久之后，可以观察到广泛的进行性萎缩。一些研究已经开始研究导致这些下降的人口统计学、损伤相关和损伤后风险因素。综合这些信息，特别是加深对可改变的损伤后因素的理解，将提高我们设计干预措施的能力，以减少中度至重度 TBI 中的神经退行性变。本系统综述旨在确定中重度 TBI 神经恶化的预后因素，从而为该人群未来的干预研究提供信息。方法 本审查方案是根据系统审查和荟萃分析方案的首选报告项目 (PRISMA-P) 指南制定和实施的。将在健康科学的协助下制定针对 MEDLINE、EMBASE PsychINFO、CINAHL、SportDiscus 和 Cochrane 对照试验中央注册库优化的搜索策略（旨在识别有关中重度 TBI 成人神经退行性疾病预后因素的文献）图书管理员。检索到的研究将由两名团队成员进行筛选。研究必须报告纵向神经影像学（即同一队列中的两次或多次扫描）或横断面研究中的神经影像学以及神经退行性变的潜在预后因素，例如人口统计学（例如性别、年龄、教育程度）、损伤（例如，严重程度、病因）或受伤后特征（例如治疗类型和持续时间、活动水平、情绪）。讨论 通过确定神经退行性变的预后因素，这项系统评价可以帮助为损伤管理以及旨在抵消可改变的预后因素（例如低水平的认知或体力活动）的影响的干预研究提供信息。反过来，这项系统评价可以增加我们对如何改善中重度 TBI 后预后的理解。系统审查注册 PROSPERO CRD42019122389。