Relationship of Hyperbaric Oxygen Therapy with Glasgow Coma Scale (GCS) Dynamics in Traumatic Brain Injury Patients

Abstract

Background: Traumatic brain injury (TBI) is one of the diseases that cause morbidity and mortality in 69 million people each year. The severity of brain injury is categorized and measured according to Glasgow Coma Scale (GCS) scoring. Hyperbaric oxygen therapy (HBOT) is a therapeutic alternative that can influence the patient's level of consciousness through intracellular mechanisms. This study aims to identify the relationship of HBOT to the GCS dynamics in TBI patients.

Methods: Meta-analysis was conducted on randomized controlled trial studies of patients diagnosed with TBI using GCS measurement. Literature searches were performed on several databases, namely Pubmed, Scopus, and Cochrane Library. Risk of bias analysis was carried out using the ROB2 tool. Other data analysis, including treatment effect measurement, heterogeneity, forest plot, and funnel plot, were analyzed in R-studio. Standardized mean difference (SMD) was calculated using a 95% confidence interval.

Result: Meta-analysis of four studies showed high heterogeneity in the I² test, which was 92.8% [84.7%; 96.6%] and t² test, which was 1.458 [0.391; 21.828]. Forest plot analysis demonstrated a significant difference in GCS between the control and intervention groups. The pooled effect favored the HBOT intervention group with SMD = 1.80 and CI 95% = 0.58; 3.03. Publication bias analysis visualized in the funnel plot resulted in scattered data in the outer area of the funnel, indicating a low study size involved in this analysis.

Conclusion: The outcome of the meta-analysis indicated the significance of hyperbaric oxygen therapy (HBOT) intervention in improving patients' consciousness measured in the Glasgow Coma Scale (GCS), compared to the control group with standard care.