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dc.contributor.authorvan Essen, Thomas A
dc.contributor.authorden Boogert, Hugo F
dc.contributor.authorCnossen, Maryse C
dc.contributor.authorde Ruiter, Godard CW
dc.contributor.authorHaitsma, Iain
dc.contributor.authorPolinder, Suzanne
dc.contributor.authorSteyerberg, Ewout W
dc.contributor.authorMenon, David
dc.contributor.authorMaas, Andrew IR
dc.contributor.authorLingsma, Hester F
dc.contributor.authorPeul, Wilco C
dc.contributor.authorCENTER-TBI Investigators and Participants
dc.date.accessioned2020-04-09T23:30:42Z
dc.date.available2020-04-09T23:30:42Z
dc.date.issued2019-03
dc.identifier.issn0001-6268
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/304252
dc.description.abstractBACKGROUND: 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. CONCLUSION: Despite 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.
dc.format.mediumPrint-Electronic
dc.languageeng
dc.publisherSpringer Science and Business Media LLC
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectCENTER-TBI Investigators and Participants
dc.subjectHumans
dc.subjectMonitoring, Physiologic
dc.subjectTrauma Centers
dc.subjectEurope
dc.subjectDecompressive Craniectomy
dc.subjectSurveys and Questionnaires
dc.subjectClinical Decision-Making
dc.subjectNeurosurgeons
dc.subjectBrain Injuries, Traumatic
dc.titleVariation in neurosurgical management of traumatic brain injury: a survey in 68 centers participating in the CENTER-TBI study.
dc.typeArticle
prism.endingPage449
prism.issueIdentifier3
prism.publicationDate2019
prism.publicationNameActa Neurochir (Wien)
prism.startingPage435
prism.volume161
dc.identifier.doi10.17863/CAM.51332
dcterms.dateAccepted2018-11-30
rioxxterms.versionofrecord10.1007/s00701-018-3761-z
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2019-03
dc.contributor.orcidMenon, David [0000-0002-3228-9692]
dc.identifier.eissn0942-0940
rioxxterms.typeJournal Article/Review
pubs.funder-project-idEuropean Commission (602150)
cam.issuedOnline2018-12-19


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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International