TY - JOUR
T1 - Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury
T2 - A survey in 66 neurotrauma centers participating in the CENTER-TBI study
AU - CENTER-TBI Investigators
AU - Cnossen, Maryse C.
AU - Huijben, Jilske A.
AU - van der Jagt, Mathieu
AU - Volovici, Victor
AU - van Essen, Thomas
AU - Polinder, Suzanne
AU - Nelson, David
AU - Ercole, Ari
AU - Stocchetti, Nino
AU - Citerio, Giuseppe
AU - Peul, Wilco C.
AU - Maas, Andrew I.R.
AU - Menon, David
AU - Steyerberg, Ewout W.
AU - Lingsma, Hester F.
AU - Adams, Hadie
AU - Alessandro, Masala
AU - Allanson, Judith
AU - Amrein, Krisztina
AU - Andaluz, Norberto
AU - Andelic, Nada
AU - Andrea, Nanni
AU - Andreassen, Lasse
AU - Anke, Audny
AU - Antoni, Anna
AU - Ardon, Hilko
AU - Audibert, Gérard
AU - Azouvi, Philippe
AU - Baciu, Camelia
AU - Bacon, Andrew
AU - Badenes, Rafael
AU - Baglin, Trevor
AU - Bartels, Ronald
AU - Barzó, Pál
AU - Bauerfeind, Ursula
AU - Beer, Ronny
AU - Belda, Francisco Javier
AU - Bellander, Bo Michael
AU - Belli, Antonio
AU - Bellier, Rémy
AU - Benali, Habib
AU - Benard, Thierry
AU - Berardino, Maurizio
AU - Beretta, Luigi
AU - Beynon, Christopher
AU - Bilotta, Federico
AU - Binder, Harald
AU - Biqiri, Erta
AU - Blaabjerg, Morten
A2 - Auslands, Kaspars
N1 - Funding Information:
Data used in the preparation of this article were obtained in the context of CENTER-TBI, a large collaborative project with the support of the European Commission Seventh Framework program (602150). In addition, TvE and WCP were supported by a grant from the Dutch Brain Foundation (Hersenstichting Nederland) for the Neurotraumatology Quality Registry (Net-QuRe) study.
Publisher Copyright:
© 2017 The Author(s).
PY - 2017/9/6
Y1 - 2017/9/6
N2 - 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.
AB - 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.
KW - Comparative effectiveness research
KW - ICP
KW - ICU
KW - Intracranial hypertension
KW - Survey
KW - Traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=85028927488&partnerID=8YFLogxK
U2 - 10.1186/s13054-017-1816-9
DO - 10.1186/s13054-017-1816-9
M3 - Article
C2 - 28874206
AN - SCOPUS:85028927488
SN - 1364-8535
VL - 21
JO - Critical Care
JF - Critical Care
IS - 1
M1 - 233
ER -