Acupuncture for Patients in Coma after Traumatic Brain Injury: Systematic Review and Meta-Analysis

Context . Traumatic brain injury (TBI) is an injury to the brain that occurs as a result of a direct impact, and affected persons are usually in a long-term coma. The evidence of the safety and effectiveness of acupuncture to treat coma is still not convincing. Objective . The study intended to assess the effectiveness and safety of acupuncture for arousing a patient in a coma following TBI. Design . Medlin, Embase, CENTRAL, and 4 Chinese medical databases were searched from their inception to March 1, 2018, without language restrictions. The dataset included randomized controlled trials (RCTs) that examined acupuncture as a therapy for arousing patients in a coma after TBI. The literature was screened ;the data were extracted ;and the methodological quality of the included studies was assessed. Meta-analyses were performed on the included data. Setting . This study was conducted at Tianjin University of Traditional Chinese Medicine (Tianjin City, China). Participants . Participants in the selected RCTs were people of any age and either gender who were in a coma caused by TBI. Interventions . The intervention group in the selected RCTs had received acupuncture for TBI, either as a sole therapy or combined with other treatments, and the control group had received placebo acupuncture, sham acupuncture, conventional treatments, or other treatments. The interventions included traditional acupuncture, electroacupuncture, ear acupuncture, and scalp acupuncture. Outcome Measures . The research team measured the Glasgow Outcome Score (GOS), wake-promoting rates, as well as the Glasgow Coma Score (GCS). Results . Of 884 potentially relevant trials, 24 RCTs met the inclusion criteria. The results of the meta-analysis suggested that the acupuncture group's coma state was significantly lessened after treatment compared with the control on GOS (RR, 1.95, 95% CI [1.64 to 2.31], P < .01; I-2=0%), wake-promoting rates (RR, 1.48, 95% CI [1.19 to 1.83], P<.01; I-2= 52%), and GCS (MD, 1.78, 95% CI [1.10 to 2.45], P < .01; I-2 = 52%) Conclusion . The systematic review and meta-analysis has suggested that acupuncture can be an effective treatment for patients unconscious following TBI. However, the evidence was too weak for medical practitioners to routinely recommend acupuncture for clinical treatment; further large, rigorously designed studies are needed.