Variation in neurosurgical management of traumatic brain injury: a survey in 68 centers participating in the CENTER-TBI study.
dc.contributor.author | van Essen, Thomas A | |
dc.contributor.author | den Boogert, Hugo F | |
dc.contributor.author | Cnossen, Maryse C | |
dc.contributor.author | de Ruiter, Godard CW | |
dc.contributor.author | Haitsma, Iain | |
dc.contributor.author | Polinder, Suzanne | |
dc.contributor.author | Steyerberg, Ewout W | |
dc.contributor.author | Menon, David | |
dc.contributor.author | Maas, Andrew IR | |
dc.contributor.author | Lingsma, Hester F | |
dc.contributor.author | Peul, Wilco C | |
dc.contributor.author | CENTER-TBI Investigators and Participants | |
dc.date.accessioned | 2020-04-09T23:30:42Z | |
dc.date.available | 2020-04-09T23:30:42Z | |
dc.date.issued | 2019-03 | |
dc.identifier.issn | 0001-6268 | |
dc.identifier.uri | https://www.repository.cam.ac.uk/handle/1810/304252 | |
dc.description.abstract | 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. 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.medium | Print-Electronic | |
dc.language | eng | |
dc.publisher | Springer Science and Business Media LLC | |
dc.rights | Attribution 4.0 International | |
dc.rights.uri | https://creativecommons.org/licenses/by/4.0/ | |
dc.subject | CENTER-TBI Investigators and Participants | |
dc.subject | Humans | |
dc.subject | Monitoring, Physiologic | |
dc.subject | Trauma Centers | |
dc.subject | Europe | |
dc.subject | Decompressive Craniectomy | |
dc.subject | Surveys and Questionnaires | |
dc.subject | Clinical Decision-Making | |
dc.subject | Neurosurgeons | |
dc.subject | Brain Injuries, Traumatic | |
dc.title | Variation in neurosurgical management of traumatic brain injury: a survey in 68 centers participating in the CENTER-TBI study. | |
dc.type | Article | |
prism.endingPage | 449 | |
prism.issueIdentifier | 3 | |
prism.publicationDate | 2019 | |
prism.publicationName | Acta Neurochir (Wien) | |
prism.startingPage | 435 | |
prism.volume | 161 | |
dc.identifier.doi | 10.17863/CAM.51332 | |
dcterms.dateAccepted | 2018-11-30 | |
rioxxterms.versionofrecord | 10.1007/s00701-018-3761-z | |
rioxxterms.version | VoR | |
rioxxterms.licenseref.uri | http://www.rioxx.net/licenses/all-rights-reserved | |
rioxxterms.licenseref.startdate | 2019-03 | |
dc.contributor.orcid | Menon, David [0000-0002-3228-9692] | |
dc.identifier.eissn | 0942-0940 | |
rioxxterms.type | Journal Article/Review | |
pubs.funder-project-id | European Commission (602150) | |
cam.issuedOnline | 2018-12-19 |
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