Intervention (Assessment factor of interest)

Comparator (Alternative assessment factor)


Postacute phase severe TBI

Preinjury creatine supplementation

Preinjury nonsupplemented diet

Signs and symptoms of TBI, e.g., reduction in headaches, fatigue, and depression and improved cognitive function as well as identifying potential negative side effects

Acute moderate to severe TBI

Zinc administration above DRI level (timing—e.g., hours postinjury, dose and duration—TBD)

Zinc at optimal levels (DRI)

Enhanced memory, reduction in depression, and anxiety symptoms as well as identifying potential negative side effects

Chronic TBI patient

Various counseling theories and strategies (e.g., memory books, motivational interviewing, problem-solving, self-monitoring)

Comparator counseling theories and strategies

Optimal dietary intake matching nutrient needs

Severe TBI with multiple trauma injuries, postacute phase

Branched-chain amino acids as % of total amino acid intake (IV or diet with varying amounts of leucine, isoleucine, and valine—doses TBD, duration < 1 week)

Normal amino acid formula or nonsupplemented diet (baseline dose TBD)

Disability Rating Scale Score, memory or cognitive functioning

TBI, chronic

Novel nutrition therapies sold as dietary supplements (e.g., combinations of resveratrol, curcumin, polyphenols, creatine and CDP-choline)

Nonsupplemented diet (baseline doses TBD)

Improved cognitive function (indicator TBD) as well as identifying potential negative side effects

Monitoring/evaluating questions

TBI patients (by mild, moderate, severe over specified time and event intervals)

Reassessment of energy needs (RMR)

Original RMR

Significant differences between original RMR and reassessed RMR

TBI patients

Brain-specific biomarkers for improvement in brain function

Other assessment biomarkers

Improved brain function

aTo aid those preparing future clinical practice guidelines for severe TBI, the questions have been formatted in the Population/Participant, Intervention, Comparator, Outcome (PICO) format. The questions are organized by the step in the care process to which the questions apply, i.e., assessment procedures, types of interventions to be selected, and the types of monitoring and evaluating parameters to be used.

bStrauss, S. E., W. S. Richardson, P. Glasziou, and R. B. Haynes. 2005. Evidence-based medicine: How to practice and teach EBM. Edinburgh: Churchill Livingstone.

cGuyatt, G., R. Drummond, M. O. Meade, and D. J. Cook, eds. 2008. Users’ guides to the medical literature: Amanual for evidence-based clinical practice, 2nd Edition. Chicago: American Medical Association.

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