• João Vitor Miranda Porto de Oliveira, André Luiz Freitas de Oliveira Júnior, Lucas Piason de Freitas Martins, Henrique Nascimento Dourado, Isaac Rego Purificação, Angelos G Kolias, Wellingson Silva Paiva, and SollaDavi Jorge FontouraDJF3NIHR Global Health Research Group on Neurotrauma, University of Cambridge, United Kingdom.5Division of Neurosurgery, Department of Neurology, Hospital das Clínicas of the Faculty of Medicine, University of São Paulo, Brazil..
• 1Division of Neurosurgery, Department of Surgery, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.
• J. Neurosurg. 2024 Oct 1; 141 (4): 887894887-894.

ObjectiveSpin is characterized as a misinterpretation of results that, whether deliberate or unintentional, culminates in misleading conclusions and steers readers toward an excessively optimistic perspective of the data. The primary objective of this systematic review was to estimate the prevalence and nature of spin within the traumatic brain injury (TBI) literature. Additionally, the identification of associated factors is intended to provide guidance for future research practices.MethodsThe Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations were followed. A search of the MEDLINE/PubMed database was conducted to identify English-language articles published between January 1960 and July 2020. Inclusion criteria encompassed randomized controlled trials (RCTs) that exclusively enrolled TBI patients, investigating various interventions, whether surgical or nonsurgical, and that were published in high-impact journals. Spin was defined as 1) a focus on statistically significant results not based on the primary outcome; 2) interpreting statistically nonsignificant results for a superiority analysis of the primary outcome; 3) claiming or emphasizing the beneficial effect of the treatment despite statistically nonsignificant results; 4) conclusion focused in the per-protocol or as-treated analysis instead of the intention-to-treat (ITT) results; 5) incorrect statistical analysis; or 6) republication of a significant secondary analysis without proper acknowledgment of the primary outcome analysis result. Primary outcomes were those explicitly reported as such in the published article. Studies without a clear primary outcome were excluded. The study characteristics were described using traditional descriptive statistics and an exploratory inferential analysis was performed to identify those associated with spin. The studies' risk of bias was evaluated by the Cochrane Risk of Bias Tool.ResultsA total of 150 RCTs were included and 22% (n = 33) had spin, most commonly spin types 1 and 3. The overall risk of bias (p < 0.001), a neurosurgery department member as the first author (p = 0.009), absence of a statistician among authors (p = 0.042), and smaller sample sizes (p = 0.033) were associated with spin.ConclusionsThe prevalence of spin in the TBI literature is high, even at leading medical journals. Studies with higher risks of bias are more frequently associated with spin. Critical interpretation of results and authors' conclusions is advisable regardless of the study design and published journal.

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