Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury: a survey in 66 neurotrauma centers participating in the CENTER-TBI study

被引：95

作者：

Cnossen, Maryse C. ^{[1
]}

Huijben, Jilske A. ^{[1
]}

van der Jagt, Mathieu ^{[2
]}

Volovici, Victor ^{[1
,3
]}

van Essen, Thomas ^{[4
]}

Polinder, Suzanne ^{[1
]}

Nelson, David ^{[5
]}

Ercole, Ari ^{[6
]}

Stocchetti, Nino ^{[7
,8
]}

Citerio, Giuseppe ^{[9
,10
]}

Peul, Wilco C. ^{[4
,11
]}

Maas, Andrew I. R. ^{[12
,13
]}

Menon, David ^{[6
]}

Steyerberg, Ewout W. ^{[1
,14
]}

Lingsma, Hester F. ^{[1
]}

机构：

[1] Erasmus MC, Ctr Med Decis Making, Dept Publ Hlth, Rotterdam, Netherlands

[2] Erasmus MC, Dept Intens Care, Rotterdam, Netherlands

[3] Erasmus MC, Dept Neurosurg, Rotterdam, Netherlands

[4] Leiden Univ, Med Ctr, Dept Neurosurg, Leiden, Netherlands

[5] Karolinska Inst, Sect Perioperat Med & Intens Care, Dept Physiol & Pharmacol, Stockholm, Sweden

[6] Univ Cambridge, Addenbrookes Hosp, Div Anesthesia, Cambridge, England

[7] Univ Milan, Dept Pathophysiol & Transplants, Milan, Italy

[8] Fdn IRCCS Ca Granda, Osped Maggiore Policlin, Dept Anesthesia & Crit Care, Neurosci Intens Care Unit, Milan, Italy

[9] Univ Milano Bicocca, Sch Med & Surg, Milan, Italy

[10] ASST Monza, San Gerardo Hosp, Neurointens Care Unit, Monza, Italy

[11] Haaglanden Med Ctr, Dept Neurosurg, The Hague, Netherlands

[12] Antwerp Univ Hosp, Dept Neurosurg, Edegem, Belgium

[13] Univ Antwerp, Edegem, Belgium

[14] Leiden Univ, Med Ctr, Dept Med Stat & Bioinformat, Leiden, Netherlands

来源：

CRITICAL CARE | 2017年 / 21卷

关键词：

Traumatic brain injury; Intracranial hypertension; ICP; ICU; Comparative effectiveness research; Survey; EUROPEAN-BRAIN; MANAGEMENT; CARE; PRESSURE; MODERATE; IMPACT;

D O I：

10.1186/s13054-017-1816-9

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background: No definitive evidence exists on how intracranial hypertension should be treated in patients with traumatic brain injury (TBI). It is therefore likely that centers and practitioners individually balance potential benefits and risks of different intracranial pressure (ICP) management strategies, resulting in practice variation. The aim of this study was to examine variation in monitoring and treatment policies for intracranial hypertension in patients with TBI. Methods: A 29-item survey on ICP monitoring and treatment was developed on the basis of literature and expert opinion, and it was pilot-tested in 16 centers. The questionnaire was sent to 68 neurotrauma centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Results: The survey was completed by 66 centers (97% response rate). Centers were mainly academic hospitals (n = 60, 91%) and designated level I trauma centers (n = 44, 67%). The Brain Trauma Foundation guidelines were used in 49 (74%) centers. Approximately 90% of the participants (n = 58) indicated placing an ICP monitor in patients with severe TBI and computed tomographic abnormalities. There was no consensus on other indications or on peri-insertion precautions. We found wide variation in the use of first-and second-tier treatments for elevated ICP. Approximately half of the centers were classified as using a relatively aggressive approach to ICP monitoring and treatment (n = 32, 48%), whereas the others were considered more conservative (n = 34, 52%). Conclusions: Substantial variation was found regarding monitoring and treatment policies in patients with TBI and intracranial hypertension. The results of this survey indicate a lack of consensus between European neurotrauma centers and provide an opportunity and necessity for comparative effectiveness research.

引用

页数：12

共 21 条

[1] Impact of intracranial pressure and cerebral perfusion pressure on severe disability and mortality after head injury [J].

Balestreri, Marcella ;

Czosnyka, Marek ;

Hutchinson, Peter ;

Steiner, Luzius A. ;

Hiler, Magda ;

Smielewski, Piotr ;

Pickard, John D. .

NEUROCRITICAL CARE, 2006, 4 (01) :8-13

[2] A most stubborn bias: no adjustment method fully resolves confounding by indication in observational studies [J].

Bosco, Jaclyn L. F. ;

Silliman, Rebecca A. ;

Thwin, Soe Soe ;

Geiger, Ann M. ;

Buist, Diana S. M. ;

Prout, Marianne N. ;

Yood, Marianne Ulcickas ;

Haque, Reina ;

Wei, Feifei ;

Lash, Timothy L. .

JOURNAL OF CLINICAL EPIDEMIOLOGY, 2010, 63 (01) :64-74

[3] A State-of-the-Science Overview of Randomized Controlled Trials Evaluating Acute Management of Moderate-to-Severe Traumatic Brain Injury [J].

Bragge, Peter ;

Synnot, Anneliese ;

Maas, Andrew I. ;

Menon, David K. ;

Cooper, D. James ;

Rosenfeld, Jeffrey V. ;

Gruen, Russell L. .

JOURNAL OF NEUROTRAUMA, 2016, 33 (16) :1461-1478

[4] Guidelines for the Management of Severe Traumatic Brain Injury: Editor's commentary [J].

Bullock, M. Ross ;

Povlishock, John T. .

JOURNAL OF NEUROTRAUMA, 2007, 24 :VII-VIII

[5] Variation in Structure and Process of Care in Traumatic Brain Injury: Provider Profiles of European Neurotrauma Centers Participating in the CENTER-TBI Study [J].

Cnossen, Maryse C. ;

Polinder, Suzanne ;

Lingsma, Hester F. ;

Maas, Andrew I. R. ;

Menon, David ;

Steyerberg, Ewout W. .

PLOS ONE, 2016, 11 (08)

[6] Causes and Consequences of Treatment Variation in Moderate and Severe Traumatic Brain Injury: A Multicenter Study [J].

Criossen, Maryse C. ;

Polinder, Suzanne ;

Andriessen, Teuntje M. ;

van der Naalt, Joukje ;

Haitsma, Iain ;

Horn, Janneke ;

Franschman, Gaby ;

Vos, Pieter E. ;

Steyerberg, Ewout W. ;

Lingsma, Hester .

CRITICAL CARE MEDICINE, 2017, 45 (04) :660-669

[7] R3-Survey of traumatic brain injury management in European Brain IT centres year 2001 [J].

Enblad, P ;

Nilsson, P ;

Chambers, I ;

Citerio, G ;

Fiddes, H ;

Howells, T ;

Kiening, K ;

Ragauskas, A ;

Sahuquillo, J ;

Yau, YH ;

Contant, C ;

Piper, I .

INTENSIVE CARE MEDICINE, 2004, 30 (06) :1058-1065

[8]

European Commission, 2007, SOC SIT EUR UN 2007, P1

[9] Marked improvement in adherence to traumatic brain injury guidelines in United States trauma centers [J].

Hesdorffer, Dale C. ;

Ghajar, Jamshid .

JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2007, 63 (04) :841-847

[10]

I.B.M. Corp, 2021, IBM SPSS Statistics for Windows

← 1 2 3 →