Repository logo
 

Variation in guideline implementation and adherence regarding severe traumatic brain injury treatment: a CENTER-TBI survey study in Europe

Accepted version
Peer-reviewed

Type

Article

Change log

Authors

Volovici, V 
Cnossen, MC 
Citerio, G 
Stocchetti, N 

Abstract

Guidelines may reduce practice variation and optimize patient care. We aimed to study differences in guideline use in the management of traumatic brain injury (TBI) patients and analyze reasons for guideline non-adherence. As part of a prospective, observational, multi-center European cohort study, participants from 68 centers in 20 countries were asked to complete 72-item questionnaires regarding their management of severe TBI. Six questions with multiple sub-questions focused on guideline use and implementation. Questionnaires were completed by 65 centers. Of these, 49 (75%) reported use of the Brain Trauma Foundation Guidelines for the medical management of TBI or related institutional protocols, 11 (17%) used no guidelines and 5 used other guidelines (8%). Of 54 centers reporting use of any guidelines, 41 (75%) relied on written guidelines. Four centers of the 54 (7%) reported no formal implementation efforts. Structural attention to the guidelines during daily clinical rounds was reported by 21 centers (38%). The most often reported reasons for non-adherence were ‘every patient is unique’ and the presence of extracranial injuries, both for centers that did and did not report the use of guidelines. There is substantial variability in the use and implementation of guidelines in neurotrauma centers in Europe. Further research is needed to strengthen the evidence underlying guidelines and to overcome implementation barriers.

Description

Keywords

CENTER-TBI, European, Guideline adherence, Guidelines, Implementation, Implementation barriers, Severe TBI, Brain Injuries, Traumatic, Cohort Studies, Europe, Guideline Adherence, Humans, Prospective Studies, Surveys and Questionnaires, Trauma Centers

Journal Title

World Neurosurgery

Conference Name

Journal ISSN

1878-8750
1878-8769

Volume Title

Publisher

Elsevier BV
Sponsorship
European Commission (602150)