Variation in neurosurgical management of traumatic brain injury: a survey in 68 centers participating in the CENTER-TBI study
Background: Neurosurgical management of traumatic brain injury (TBI) is challenging, with only low-quality evidence. We aimed to explore differences in neurosurgical strategies for TBI across Europe. Methods: A survey was sent to 68 centers participating in the Collaborative European Neurotrauma Eff...
Gespeichert in:
| Hauptverfasser: | , , , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
2019
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| In: |
Acta neurochirurgica
Year: 2018, Jahrgang: 161, Heft: 3, Pages: 435-449 |
| ISSN: | 0942-0940 |
| DOI: | 10.1007/s00701-018-3761-z |
| Online-Zugang: | Verlag, Volltext: https://doi.org/10.1007/s00701-018-3761-z
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| Verfasserangaben: | Thomas A. van Essen [und 319 weitere] on behalf of the CENTER-TBI Investigators and Participants* |
| Zusammenfassung: | Background: Neurosurgical management of traumatic brain injury (TBI) is challenging, with only low-quality evidence. We aimed to explore differences in neurosurgical strategies for TBI across Europe. Methods: A survey was sent to 68 centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. The questionnaire contained 21 questions, including the decision when to operate (or not) on traumatic acute subdural hematoma (ASDH) and intracerebral hematoma (ICH), and when to perform a decompressive craniectomy (DC) in raised intracranial pressure (ICP).Results: The survey was completed by 68 centers (100%). On average, 10 neurosurgeons work in each trauma center. In all centers, a neurosurgeon was available within 30 min. Forty percent of responders reported a thickness or volume threshold for evacuation of an ASDH. Most responders (78%) decide on a primary DC in evacuating an ASDH during the operation, when swelling is present. For ICH, 3% would perform an evacuation directly to prevent secondary deterioration and 66% only in case of clinical deterioration. Most respondents (91%) reported to consider a DC for refractory high ICP. The reported cut-off ICP for DC in refractory high ICP, however, differed: 60% uses 25 mmHg, 18% 30 mmHg, and 17% 20 mmHg. Treatment strategies varied substantially between regions, specifically for the threshold for ASDH surgery and DC for refractory raised ICP. Also within center variation was present: 31% reported variation within the hospital for inserting an ICP monitor and 43% for evacuating mass lesions.ConclusionDespite a homogeneous organization, considerable practice variation exists of neurosurgical strategies for TBI in Europe. These results provide an incentive for comparative effectiveness research to determine elements of effective neurosurgical care. |
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| Beschreibung: | First Online: 19 December 2018 Gesehen am 18.07.2019 *CENTER-TBI Investigators and Participants: Cecilia Ackerlund, Christopher Beynon, Oliver Sakowitz, Edgar Santos, Alexander Younsi [und 315 weitere] |
| Beschreibung: | Online Resource |
| ISSN: | 0942-0940 |
| DOI: | 10.1007/s00701-018-3761-z |