| Title |
Variation in neurosurgical management of traumatic brain injury: a survey in 68 centers participating in the CENTER-TBI study / |
| Authors |
Van Essen, Thomas A ; den Boogert, Hugo F ; Cnossen, Maryse C ; de Ruiter, Godard C.W ; Haitsma, Iain ; Polinder, Suzanne ; Steyerberg, Ewout W ; Menon, David ; Maas, Andrew I.R ; Lingsma, Hester F ; Peul, Wilco C |
| DOI |
10.1007/s00701-018-3761-z |
| Full Text |
|
| Is Part of |
Acta neurochirurgica.. Vienna : Springer. 2019, vol. 161, iss. 3, p. 435-449.. ISSN 0001-6268. eISSN 0942-0940 |
| Keywords [eng] |
acute subdural hematoma ; neurosurgery ; practice variation ; traumatic brain injury |
| Abstract [eng] |
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. |
| Published |
Vienna : Springer |
| Type |
Journal article |
| Language |
English |
| Publication date |
2019 |
| CC license |
|
