Initial CT Imaging Predicts Mortality in Severe Traumatic Brain Injuries in Pediatric Population—A Systematic Review and Meta-Analysis
Round 1
Reviewer 1 Report
The manuscript presents a systematic review and meta-analysis to a clinical issue that is broadly studied - CT initial findings in severe traumatic brain injuries.
Major issues:
a. The definition of TBIs and its management strategies do not link with the research question. IT is nuclear to understand the purpose of the study why is this relevant, ie TBI severity vs managament vs initial predictors/ indicators.
b. It should be stated how this results improve the intial approach to a patient with TBI.
Minor issues:
1. Abstract: Data Sources- An experienced librarian 16 searched for all existing studies based on the inclusion and exclusion criteria.
Please state the databases used.
2. It is missing the Introduction header
The manuscript is weel written and follow a correct methological strategy but it lacks to explore further the research question and integrate it with the current state-of-.the-art.
Author Response
Reviewer 1: Comments and Suggestions for Authors
The manuscript presents a systematic review and meta-analysis to a clinical issue that is broadly studied - CT initial findings in severe traumatic brain injuries.
Major issues:
- The definition of TBIs and its management strategies do not link with the research question. IT is nuclear to understand the purpose of the study why is this relevant, ie TBI severity vs managament vs initial predictors/ indicators.
- It should be stated how this results improve the intial approach to a patient with TBI.
Response- Thanks for your comments. The manuscript is reviewed, edited and edits are highlighted.
TBI patients get standard but intense care at the time of their hospital admission. Most of these patients could not reliability examined clinically to assess the extent of their injury. So imaging plays a significant role in the assessment of the extent of injury in these patients. Patients with severe TBI have higher in-hospital mortality. We wanted to assess if initial imaging features could be associated with mortality in these patients with TBI. If so, we may be able to predict the higher likelihood of mortality in select patients based on their initial imaging. This could help management of this subgroup of patients in the future. This is part of the second paragraph of the introduction. The conclusion has been modified based on the reviewer’s comment.
It is important to state that this has not been looked at before in the literature. Ours is the first of its kind systematic review on this topic.
Minor issues:
- Abstract: Data Sources- An experienced librarian 16 searched for all existing studies based on the inclusion and exclusion criteria.
Please state the databases used.
Response- Thanks for your comments. It is now added.
- It is missing the Introduction header
Response- Thanks for your comments. It is now added.
The manuscript is weel written and follow a correct methological strategy but it lacks to explore further the research question and integrate it with the current state-of-.the-art.
Response- Thanks for your comments. It is now added to the manuscript.
Reviewer 2 Report
The article screened the statistical data of existing research，and discussed the value of initial CT imaging in predicting mortality in severe 15 traumatic brain injuries in pediatric patients. But the expression of the article still needs to be optimized.
1. Some of the content in the Imaging Findings paragraph starting from line 119 is inconsistent with the content in Table 2. The author should proofread the relevant statistical data
2. Table 2 shows the composition of the data used in the article. But if the article discusses the relationship between sex and corresponding symptoms, the sex composition corresponding to each symptom in the extracted data should be shown.
3. It is suggested to modify the representation of Figure 2. In the current version, the size of each sub-figure is inconsistent, and the amount of information on the corresponding page is too low and has some repeatability.
4. Each sub-figure in Figure 3 discusses a symptom separately, but the statistical results of the data are displayed separately according to the data source. The data from different sources should be counted as a whole and added to the picture to more clearly discuss the symptoms themselves rather than the differences between different studies.
Author Response
Reviewer 2: Comments and Suggestions for Authors
The article screened the statistical data of existing research，and discussed the value of initial CT imaging in predicting mortality in severe 15 traumatic brain injuries in pediatric patients. But the expression of the article still needs to be optimized.
- Some of the content in the Imaging Findings paragraph starting from line 119 is inconsistent with the content in Table 2. The author should proofread the relevant statistical data
Response- Thanks for your comments. The typo “26 had EDH” is fixed to “76 had EDH”
- Table 2 shows the composition of the data used in the article. But if the article discusses the relationship between sex and corresponding symptoms, the sex composition corresponding to each symptom in the extracted data should be shown.
Response- Thanks for your comments. In line 204-205, the line “However, the sex composition corresponding to each symptom was not reported in enough studies to do a metanalysis on that data” is added.
- It is suggested to modify the representation of Figure 2. In the current version, the size of each sub-figure is inconsistent, and the amount of information on the corresponding page is too low and has some repeatability.
Response- Thanks for your comments. It is now edited. Figure 2 was edited and the author ensured that the size of each graph was exactly the same: 4.87 x 3.55 cm. The graphs were made to fit on 2 rows rather than 3 so that they would take up less space and fit more information on the page. The description was edited and made shorter (to reduce the repeatability)
- Each sub-figure in Figure 3 discusses a symptom separately, but the statistical results of the data are displayed separately according to the data source. The data from different sources should be counted as a whole and added to the picture to more clearly discuss the symptoms themselves rather than the differences between different studies.
Response- Thanks for your comments. The figure 3 depicts the forest plots for each of the imaging features and their association with mortality in patients with TBI. Not all studies provided data on all of the imaging features. So we could include studies only if they described that specific imaging features and its association with mortality. So Figure 3 actually shows pooled data (not the differences between studies). Hope this provides a satisfactory explanation.
