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Crit Care. 2017 Sep 6;21(1):233. doi: 10.1186/s13054-017-1816-9.

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.

Collaborators (322)

Adams H, Alessandro M, Allanson J, Amrein K, Andaluz N, Andelic N, Andrea N, Andreassen L, Anke A, Antoni A, Ardon H, Audibert G, Auslands K, Azouvi P, Baciu C, Bacon A, Badenes R, Baglin T, Bartels R, Barzó P, Bauerfeind U, Beer R, Belda FJ, Bellander BM, Belli A, Bellier R, Benali H, Benard T, Berardino M, Beretta L, Beynon C, Bilotta F, Binder H, Biqiri E, Blaabjerg M, Borgen LS, Bouzat P, Bragge P, Brazinova A, Brehar F, Brorsson C, Buki A, Bullinger M, Bučková V, Calappi E, Cameron P, Lozano GC, Carise E, Carpenter K, Castaño-León AM, Causin F, Chevallard G, Chieregato A, Citerio G, Cnossen M, Coburn M, Coles J, Cooper JD, Correia M, Covic A, Curry N, Czeiter E, Czosnyka M, Dahyot-Fizelier C, Damas F, Damas P, Dawes H, De Keyser V, Corte FD, Depreitere B, Ding S, Dippel D, Dizdarevic K, Dulière GL, Dzeko A, Eapen G, Engemann H, Ercole A, Esser P, Ezer E, Fabricius M, Feigin VL, Feng J, Foks K, Fossi F, Francony G, Frantzén J, Freo U, Frisvold S, Furmanov A, Gagliardo P, Galanaud D, Gao G, Geleijns K, Ghuysen A, Giraud B, Glocker B, Gomez PA, Grossi F, Gruen RL, Gupta D, Haagsma JA, Hadzic E, Haitsma I, Hartings JA, Helbok R, Helseth E, Hertle D, Hill S, Hoedemaekers A, Hoefer S, Hutchinson PJ, Håberg AK, Jacobs B, Janciak I, Janssens K, Jiang JY, Jones K, Kalala JP, Kamnitsas K, Karan M, Karau J, Katila A, Kaukonen M, Keeling D, Kerforne T, Ketharanathan N, Kettunen J, Kivisaari R, Kolias AG, Kolumbán B, Kompanje E, Kondziella D, Koskinen LO, Kovács N, Kálovits F, Lagares A, Lanyon L, Laureys S, Lauritzen M, Lecky F, Ledig C, Lefering R, Legrand V, Lei J, Levi L, Lightfoot R, Lingsma H, Loeckx D, Lozano A, Luddington R, Luijten-Arts C, Andrew IRM, MacDonald S, MacFayden C, Maegele M, Majdan M, Major S, Manara A, Manhes P, Manley G, Martin D, Martino C, Maruenda A, Maréchal H, Mastelova D, Mattern J, McMahon C, Melegh B, Menon D, Menovsky T, Morganti-Kossmann C, Mulazzi D, Mutschler M, Mühlan H, Negru A, Nelson D, Neugebauer E, Newcombe V, Noirhomme Q, Nyirádi J, Oddo M, Oldenbeuving A, Oresic M, Ortolano F, Palotie A, Parizel PM, Patruno A, Payen JF, Perera N, Perlbarg V, Persona P, Peul W, Pichon N, Piilgaard H, Piippo A, Floury SP, Pirinen M, Ples H, Polinder S, Pomposo I, Psota M, Pullens P, Puybasset L, Ragauskas A, Raj R, Rambadagalla M, Rehorčíková V, Rhodes J, Richardson S, Ripatti S, Rocka S, Rodier N, Roe C, Roise O, Roks G, Romegoux P, Rosand J, Rosenfeld J, Rosenlund C, Rosenthal G, Rossaint R, Rossi S, Rostalski T, Rueckert D, de Arcaute FR, Rusnák M, Sacchi M, Sahakian B, Sahuquillo J, Sakowitz O, Sala F, Sanchez-Pena P, Sanchez-Porras R, Sandor J, Santos E, Sasse N, Sasu L, Savo D, Schipper I, Schlößer B, Schmidt S, Schneider A, Schoechl H, Schoonman G, Schou RF, Schwendenwein E, Schöll M, Sir Ö, Skandsen T, Smakman L, Smeets D, Smielewski P, Sorinola A, Stamatakis E, Stanworth S, Stegemann K, Steinbüchel N, Stevens R, Stewart W, Steyerberg EW, Stocchetti N, Sundström N, Synnot A, Szabó J, Söderberg J, Taccone FS, Tamás V, Tanskanen P, Tascu A, Taylor MS, Te Ao B, Tenovuo O, Teodorani G, Theadom A, Thomas M, Tibboel D, Tolias C, Tshibanda JL, Tudora CM, Vajkoczy P, Valeinis E, Van Hecke W, Van Praag D, Van Roost D, Van Vlierberghe E, Vyvere TV, Vanhaudenhuyse A, Vargiolu A, Vega E, Verheyden J, Vespa PM, Vik A, Vilcinis R, Vizzino G, Vleggeert-Lankamp C, Volovici V, Vulekovic P, Vámos Z, Wade D, Wang KKW, Wang L, Wildschut E, Williams G, Willumsen L, Wilson A, Wilson L, Winkler MKL, Ylén P, Younsi A, Zaaroor M, Zhang Z, Zheng Z, Zumbo F, de Lange S, de Ruiter GCW, den Boogert H, van Dijck J, van Essen TA, van Heugten C, van der Jagt M, van der Naalt J.

Author information

1
Center for Medical Decision Making, Department of Public Health, Erasmus MC, Rotterdam, The Netherlands. m.c.cnossen@erasmusmc.nl.
2
Center for Medical Decision Making, Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
3
Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands.
4
Department of Neurosurgery, Erasmus MC, Rotterdam, The Netherlands.
5
Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands.
6
Department of Physiology and Pharmacology, Section of Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden.
7
Division of Anesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
8
Department of Pathophysiology and Transplants, University of Milan, Milan, Italy.
9
Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Department of Anesthesia and Critical Care, Neuroscience Intensive Care Unit, Milan, Italy.
10
School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.
11
Neurointensive Care Unit, San Gerardo Hospital, ASST-Monza, Monza, Italy.
12
Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands.
13
Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium.
14
Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands.

Abstract

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.

KEYWORDS:

Comparative effectiveness research; ICP; ICU; Intracranial hypertension; Survey; Traumatic brain injury

PMID:
28874206
PMCID:
PMC5586023
DOI:
10.1186/s13054-017-1816-9
[Indexed for MEDLINE]
Free PMC Article

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