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Risk of Major Depressive Disorder High After Traumatic Brain Injury
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These InfoPOEMs® are selected by JNMA InfoPOEMS Editor Gregory E. Gilbert, MSPH, (Gregory.E.Gilbert@ gmail.com) and Associate InfoPOEMS Editor Amy H. Wahlquist, MS, from www.infopoems.com. InfoPOEMs® are created by experts who continuously survey medical journals worldwide. They identify and summarize valid and clinically applicable new evidence. For more information or to subscribe to e-mail alerts of InfoPOEMs®, please visit www.infopoems.com. STUDY LEVELS OF EVIDENCE (LOE) From the Centre for Evidence-Based Medicine, Oxford. For the most up-todate levels of evidence, see www.cebm. net/levels_of_evidence.asp) Therapy/Prevention/Etiology/Harm: 1a: Systematic reviews of randomized controlled trials 1b: Individual randomized controlled trials 1c: All or none randomized controlled trials 2a: Systematic reviews of cohort studies 2b: Individual cohort study or lowquality randomized controlled 2c: “Outcomes” research, ecological studies Diagnosis: 1a: Systematic review of level-1 diagnostic studies 1b: Independent blind comparison of an appropriate spectrum of consecutive patients, all of whom have undergone both the diagnostic test and the reference standard, or a clinical decision rule not validated on a second set of patients 1c: Absolute SpPins and SnNouts 2a: Systematic review of level >2 2b: Independent blind or objective comparison, study confined to a narrow spectrum of study individuals, or a diagnostic clinical rule not validated in a test set Prognosis: 1a: Systematic review of inception cohort studies 1b: Individual inception cohort study with >80% follow-up, or a clinical rule not validated on a second set of patients 1c: All or none case series 2a: Systematic review of either retrospective cohort studies or untreated control groups in RCTs 2b: Retrospective cohort study or followup of untreated control patients in an RCT, or clinical rule not validated in a test set 2c: “Outcomes” research Copyright © 1995–2010 John Wiley & Sons, Inc. All rights reserved. www.infopoems.com.
Risk of Major Depressive Disorder High After Traumatic Brain Injury Clinical Question Are adults at an increased risk of major depressive disorder following a traumatic brain injury (TBI)? Bottom Line In this study, more than half (53.1%) of the adults hospitalized following a traumatic brain injury met standard criteria for major depressive disorder (MDD) at least once during the first year after injury. (LOE = 1b) Study Design Cohort (prospective) Funding Government Setting Inpatient (any location) with outpatient follow-up Synopsis These investigators identified 559 consecutively hospitalized adults, aged 18 years or older, with TBI defined by radiologic evidence of acute trauma-induced brain injury or a Glasgow Coma scale (GCS) score of less than 13. (Patients with a GCS score of less than 13 with normal brain scans and elevated blood alcohol levels consistent with intoxication were excluded.) Study personnel conducted telephone interviews using standard validated diagnostic questionnaires every 1 month to 2 months for 12 months after the injury. Complete followup occurred for 80% of eligible patients. In the first year after TBI, 53.1% of patients met the diagnos-
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
tic criteria for MDD at least once. Among patients screening positive for MDD in the first 3 months, the median time depressed was 4 months. Factors associated with an increased risk of MDD included age less than 60 years, female, preinjury history of depression, cocaine addiction, and lifetime alcohol dependence. Comorbid anxiety was significantly increased in patients with MDD compared with those without MDD (60% vs 7%).
Reference
Bombardier CH, Fann JR, Temkin NR, Esselman PC, Barber J, Dikmen SS. Rates of major depressive disorder and clinical outcomes following traumatic brain injury. JAMA. 2010;303(19):12381245.
Once-Only Flex Sig Decreases 11-Year Cancer Mortality Clinical Question Is a once-only flexible sigmoidoscopy associated with favorable outcomes compared with no screening? Bottom Line In this large study from the United Kingdom, patients who had a single flexible sigmoidoscopy had a lower rate of developing colorectal cancer, a lower death rate from colorectal cancer, and slightly lower all-cause mortality compared with control patients. Whether this approach is as effective as serial screening or once-only colonoscopy is unknown. (LOE = 1b) Study Design Randomized controlled trial (nonblinded)
VOL. 102, NO. 10, OCTOBER 2010 967
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These InfoPOEMs® are selected by JNMA InfoPOEMS Editor Gregory E. Gilbert, MSPH, (Gregory.E.Gilbert@ gmail.com) and Associate InfoPOEMS Editor Amy H. Wahlquist, MS, from www.infopoems.com. InfoPOEMs® are created by experts who continuously survey medical journals worldwide. They identify and summarize valid and clinically applicable new evidence. For more information or to subscribe to e-mail alerts of InfoPOEMs®, please visit www.infopoems.com. STUDY LEVELS OF EVIDENCE (LOE) From the Centre for Evidence-Based Medicine, Oxford. For the most up-todate levels of evidence, see www.cebm. net/levels_of_evidence.asp) Therapy/Prevention/Etiology/Harm: 1a: Systematic reviews of randomized controlled trials 1b: Individual randomized controlled trials 1c: All or none randomized controlled trials 2a: Systematic reviews of cohort studies 2b: Individual cohort study or lowquality randomized controlled 2c: “Outcomes” research, ecological studies Diagnosis: 1a: Systematic review of level-1 diagnostic studies 1b: Independent blind comparison of an appropriate spectrum of consecutive patients, all of whom have undergone both the diagnostic test and the reference standard, or a clinical decision rule not validated on a second set of patients 1c: Absolute SpPins and SnNouts 2a: Systematic review of level >2 2b: Independent blind or objective comparison, study confined to a narrow spectrum of study individuals, or a diagnostic clinical rule not validated in a test set Prognosis: 1a: Systematic review of inception cohort studies 1b: Individual inception cohort study with >80% follow-up, or a clinical rule not validated on a second set of patients 1c: All or none case series 2a: Systematic review of either retrospective cohort studies or untreated control groups in RCTs 2b: Retrospective cohort study or followup of untreated control patients in an RCT, or clinical rule not validated in a test set 2c: “Outcomes” research Copyright © 1995–2010 John Wiley & Sons, Inc. All rights reserved. www.infopoems.com.
Risk of Major Depressive Disorder High After Traumatic Brain Injury Clinical Question Are adults at an increased risk of major depressive disorder following a traumatic brain injury (TBI)? Bottom Line In this study, more than half (53.1%) of the adults hospitalized following a traumatic brain injury met standard criteria for major depressive disorder (MDD) at least once during the first year after injury. (LOE = 1b) Study Design Cohort (prospective) Funding Government Setting Inpatient (any location) with outpatient follow-up Synopsis These investigators identified 559 consecutively hospitalized adults, aged 18 years or older, with TBI defined by radiologic evidence of acute trauma-induced brain injury or a Glasgow Coma scale (GCS) score of less than 13. (Patients with a GCS score of less than 13 with normal brain scans and elevated blood alcohol levels consistent with intoxication were excluded.) Study personnel conducted telephone interviews using standard validated diagnostic questionnaires every 1 month to 2 months for 12 months after the injury. Complete followup occurred for 80% of eligible patients. In the first year after TBI, 53.1% of patients met the diagnos-
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION
tic criteria for MDD at least once. Among patients screening positive for MDD in the first 3 months, the median time depressed was 4 months. Factors associated with an increased risk of MDD included age less than 60 years, female, preinjury history of depression, cocaine addiction, and lifetime alcohol dependence. Comorbid anxiety was significantly increased in patients with MDD compared with those without MDD (60% vs 7%).
Reference
Bombardier CH, Fann JR, Temkin NR, Esselman PC, Barber J, Dikmen SS. Rates of major depressive disorder and clinical outcomes following traumatic brain injury. JAMA. 2010;303(19):12381245.
Once-Only Flex Sig Decreases 11-Year Cancer Mortality Clinical Question Is a once-only flexible sigmoidoscopy associated with favorable outcomes compared with no screening? Bottom Line In this large study from the United Kingdom, patients who had a single flexible sigmoidoscopy had a lower rate of developing colorectal cancer, a lower death rate from colorectal cancer, and slightly lower all-cause mortality compared with control patients. Whether this approach is as effective as serial screening or once-only colonoscopy is unknown. (LOE = 1b) Study Design Randomized controlled trial (nonblinded)
VOL. 102, NO. 10, OCTOBER 2010 967