Please use this identifier to cite or link to this item: http://hdl.handle.net/1893/29278
Appears in Collections:Psychology Journal Articles
Peer Review Status: Refereed
Title: Variation in neurosurgical management of traumatic brain injury: a survey in 68 centers participating in the CENTER-TBI study
Author(s): van Essen, Thomas
den Boogert, Hugo
Cnossen, Maryse
de Ruiter, Godard
Haitsma, Iain
Polinder, Suzanne
Steyerberg, Ewout
Menon, David
Maas, Andrew
Lingsma, Hester
Peul, Wilco
Horton, Lindsay
Wilson, Lindsay
Keywords: Traumatic brain injury
Neurosurgery
Practice variation
Acute subdural hematoma
Issue Date: Mar-2019
Citation: van Essen T, den Boogert H, Cnossen M, de Ruiter G, Haitsma I, Polinder S, Steyerberg E, Menon D, Maas A, Lingsma H, Peul W, Horton L & Wilson L (2019) Variation in neurosurgical management of traumatic brain injury: a survey in 68 centers participating in the CENTER-TBI study. Acta Neurochirurgica, 161 (3), pp. 435-449. https://doi.org/10.1007/s00701-018-3761-z
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. 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.
DOI Link: 10.1007/s00701-018-3761-z
Rights: © The Author(s) 2018 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Notes: Additional co-authors: CENTER_TBI investigators and participants
Licence URL(s): http://creativecommons.org/licenses/by/4.0/

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