Guideline Adherence and Outcomes in Severe Adult Traumatic Brain Injury for the CHIRAG (Collaborative Head Injury and Guidelines) Study (original) (raw)
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Marked reduction in mortality in patients with severe traumatic brain injury
Journal of Neurosurgery, 2013
Object In spite of evidence that use of the Brain Trauma Foundation Guidelines for the Management of Severe Traumatic Brain Injury (Guidelines) would dramatically reduce morbidity and mortality, adherence to these Guidelines remains variable across trauma centers. The authors analyzed 2-week mortality due to severe traumatic brain injury (TBI) from 2001 through 2009 in New York State and examined the trends in adherence to the Guidelines. Methods The authors calculated trends in adherence to the Guidelines and age-adjusted 2-week mortality rates between January 1, 2001, and December 31, 2009. Univariate and multivariate logistic regression analyses were performed to evaluate the effect of time period on case-fatality. Intracranial pressure (ICP) monitor insertion was modeled in a 2-level hierarchical model using generalized linear mixed effects to allow for clustering by different centers. Results From 2001 to 2009, the case-fatality rate decreased from 22% to 13% (p < 0.0001), a...
2015
Traumatic brain injury (TBI) is one of the leading causes of mortality and morbidity worldwide, especially in low and middle income countries. The outcome of TBI does not only depend on the initial trauma, but is also affected by secondary neurological damage that follows the trauma. These secondary effects can be reduced by implementing an evidence based protocol of management for TBI. Aim: To evaluate the effect of TBI management protocol on short term outcome. Methods: retrospective evaluation of medical records of severe TBI patients admitted to ICU during three months prior to implementing the protocol for short term outcome (group 1), then prospective observation of short term outcome of patients with severe TBI admitted to ICU, and managed with the TBI protocol for three months. Results: there was statistically significant difference between the two groups regarding the GCS after 7 days (p=0.017), the length of ICU stay (p=0.009) and the duration of mechanical ventilation (p=...
Marked Improvement in Adherence to Traumatic Brain Injury Guidelines in United States Trauma Centers
The Journal of Trauma: Injury, Infection, and Critical Care, 2007
Background: Prior surveys of acute medical management of severe traumatic brain injury (TBI) indicate that care is fragmented and inconsistent, although Guidelines for the management of severe traumatic brain injury (guidelines) were distributed and endorsed by the American Association of Neurologic Surgeons. We conducted a survey of US trauma centers to evaluate guideline adherence, to examine predictors of adherence, and to compare our results with similar surveys conducted in 1991 and 2000.
This Commission covers a range of topics that need to be addressed to confront the global burden of TBI and reduce its effects on individuals and society: epidemiology (section 1); health economics (section 2); prevention (section 3); systems of care (section 4); clinical management (section 5); characterisation of TBI (section 6); outcome assessment (section 7); prognosis (section 8); and new directions for acquiring and implementing evidence (section 9). summarises key messages from the Commission and provides recommendations to advance clinical care and research in TBI.
JAMA Surgery, 2019
IMPORTANCE Traumatic brain injury (TBI) is a massive public health problem. While evidence-based guidelines directing the prehospital treatment of TBI have been promulgated, to our knowledge, no studies have assessed their association with survival. OBJECTIVE To evaluate the association of implementing the nationally vetted, evidence-based, prehospital treatment guidelines with outcomes in moderate, severe, and critical TBI. DESIGN, SETTING, AND PARTICIPANTS The Excellence in Prehospital Injury Care (EPIC) Study included more than 130 emergency medical services systems/agencies throughout Arizona. This was a statewide, multisystem, intention-to-treat study using a before/after controlled design with patients with moderate to critically severe TBI (US Centers for Disease Control and Prevention Barell Matrix-Type 1 and/or Abbreviated Injury Scale Head region severity Ն3) transported to trauma centers between
Moderate to Severe Traumatic Brain Injury -An Institutional Experience
Background: Traumatic brain injury (TBI) is a significant public health problem and is a leading cause of mortality in India. Incidence of Head injuries in increasing over the years may be due to increase in vehicular traffic and non adherence to traffic rules. Materials and Methods: This is a retrospective and prospective study of all the patients admitted to Government general hospital, Guntur between June 2019 and August 2019, with TBI and GCS at admission of 12 or less. Results: The Total number of cases admitted with moderate to severe TBI were 136 during period of 3 months. 42.7 years was the mean age of TBI patients and male to female ratio was 6.5:1. Mortality rate was 38.2% and majority(88%) of them belonged to severe TBI group. Conclusion:Most of the TBI's occur among the productive age group males and carry a very high mortality rate. Impact model may not be highly accurate at our institute however can still give a good and objective way of prognostic assessment.
Journal of Neurotrauma
Brain Trauma Foundation (BTF) Guidelines for medical management of severe traumatic brain injury (TBI) have become a global standard for the treatment of TBI patients. We aim to explore the evolution of the guidelines for the management of severe TBI. We reviewed the four editions of the BTF guidelines published over the past 20 years. The 1996 and 2000 editions were merged because of minimal differences, and are referred to as the 1996 edition. We described changes in topics and recommendations over time, and analyzed predictors of survival of recommendations with logistical regression. The guidelines contained 27 recommendations on 18 topics in 2016, 35 recommendations on 15 topics in 2007, and 22 recommendations on 10 topics in 1996. Substantial delays were found between the search for evidence and the guideline publication, ranging from 18 to 34 months. The overall body of evidence comprised 189 studies on 18 topics in 2016, compared with 156 studies on 15 topics in 2007 and 180 studies on 10 topics in 1996. Over time, a total of 175 studies were discarded from the evidence base following more rigorous grading of evidence. A total of 15/23 (65%) of the 1996/ 2000 recommendations were discarded over time. Out of 12 new recommendations introduced in the 2007 edition, 8 (66%) were discarded in 2016. Survival of recommendations varied between 33% and 100% for level I recommendations and between 11% and 31% for level II and III recommendations. No predictors of survival of recommendations were found. Substantial delays exist between literature search and publication, and survival rate of TBI guideline recommendations is poor. These factors may adversely affect currency and adherence to guidelines. The TBI community should take responsibility for improving the quality of the evidence base and ensuring that the translation of the evidence into guidelines supports clinicians in daily clinical practice.