Variation in neurosurgical management of traumatic brain injury

• Verfasst von: Essen, Thomas van [VerfasserIn]
• Verfasst von: Beynon, Christopher [VerfasserIn]
• Verfasst von: Sakowitz, Oliver [VerfasserIn]
• Verfasst von: Santos, Edgar [VerfasserIn]
• Verfasst von: Younsi, Alexander [VerfasserIn]
• Titel: Variation in neurosurgical management of traumatic brain injury
• Titelzusatz: a survey in 68 centers participating in the CENTER-TBI study
• Verf.angabe: Thomas A. van Essen [und 319 weitere] on behalf of the CENTER-TBI Investigators and Participants*
• Jahr: 2019
• Jahr des Originals: 2018
• Umfang: 15 S.
• Fussnoten: First Online: 19 December 2018 ; Gesehen am 18.07.2019 ; *CENTER-TBI Investigators and Participants: Cecilia Ackerlund, Christopher Beynon, Oliver Sakowitz, Edgar Santos, Alexander Younsi [und 315 weitere]
• Titel Quelle: Enthalten in: Acta neurochirurgica
• Ort Quelle: Wien [u.a.] : Springer, 1950
• Jahr Quelle: 2019
• Band/Heft Quelle: 161(2019), 3, Seite 435-449
• ISSN Quelle: 0942-0940
• DOI: doi:10.1007/s00701-018-3761-z
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Acute subdural hematoma
• Sach-SW: Neurosurgery
• Sach-SW: Practice variation
• Sach-SW: Traumatic brain injury
• K10plus-PPN: 1669414396

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.ConclusionDespite 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.