Timing for XXXX in traumatic brain injury: an evidence-based review.

@entity1 @entity1545 @entity932 @entity1150 @entity21 @entity130
Multiple studies have addressed @entity1150 timing in traumatic @entity1545 . However, a precise time for safe and effective chemoprophylaxis is uncertain according to experts. A comprehensive literature review on @entity1545 was performed to delineate temporal proportions for 1) spontaneous @entity932 ( @entity932 ) progression, 2) post-chemoprophylaxis @entity932 expansion, and 3) post-chemoprophylaxis @entity1150 . Twenty-three publications were found including more than 5,000 @entity1 . Spontaneous @entity932 expansion at 24 hours was 14.8% in 1,437 @entity1 from chemoprophylaxis studies and 29.9% in 1,257 @entity1 not in chemoprophylaxis studies (P   <   0.0001). With low-risk @entity932 (n   =   136), 99% of spontaneous @entity932 expansion occurred within 48 hours. In moderate or high-risk @entity932 (n   =   109), 18% of spontaneous @entity932 expansion occurred after day 3. If @entity1 with pre-chemoprophylaxis @entity932 expansion are included, the post-chemoprophylaxis @entity932 expansion proportion was 5.6% in 1,258 @entity1 with chemoprophylaxis on days 1 to 3 and was 1.5% in 401 with chemoprophylaxis after day 3 (P   =   0.0116). If @entity1 with pre-chemoprophylaxis @entity932 expansion were excluded, the post-chemoprophylaxis @entity932 expansion proportion was 3.1% in 1,570 @entity1 with chemoprophylaxis on days 1 to 3 and was 2.8% in 582 with chemoprophylaxis after day 3 (P   =   0.7769). In @entity21 (n   =   188), the post-chemoprophylaxis @entity932 expansion proportion was 1.6% with chemoprophylaxis after day 3. The @entity1150 proportions were as follows: chemoprophylaxis on days 1 to 3, 2.6% in 2,384 @entity1 ; chemoprophylaxis on days 4 or 5, 2.2% in 831; and chemoprophylaxis on day 8, 14.1% in 99 (P   <   0.0001). Spontaneous @entity932 expansion proportions at 24 hours substantially vary between chemoprophylaxis and non-chemoprophylaxis studies. Chemoprophylaxis should not be given within 3 days of injury for moderate-risk or high-risk @entity932 . Chemoprophylaxis is reasonable when low-risk @entity1 have not developed @entity932 expansion within 48 hours @entity130 . Chemoprophylaxis is also acceptable after day 3, when low-risk @entity1 develop @entity932 expansion within 48 hours @entity130 . In @entity21 @entity1 who have not developed @entity932 within 72 hours, chemoprophylaxis is reasonable. @entity1150 proportions significantly increase when chemoprophylaxis is withheld for greater than 7 days.
