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Acta Neurochir (Wien). 2019 Mar;161(3):435-449. doi: 10.1007/s00701-018-3761-z. Epub 2018 Dec 19.

Variation in neurosurgical management of traumatic brain injury: a survey in 68 centers participating in the CENTER-TBI study.

Collaborators (321)

Cecilia A, Hadie A, Vanni A, Judith A, Krisztina A, Norberto A, Nada A, Lasse A, Azasevac A, Audny A, Anna A, Hilko A, Gérard A, Kaspars A, Philippe A, Luisa AM, Camelia B, Rafael B, Ronald B, Pál B, Ursula B, Romuald B, Ronny B, Javier BF, Bo-Michael B, Antonio B, Rémy B, Habib B, Thierry B, Maurizio B, Luigi B, Christopher B, Federico B, Harald B, Erta B, Morten B, den Hugo B, Pierre B, Peter B, Alexandra B, Vibeke B, Joanne B, Camilla B, Andras B, Monika B, Emiliana C, Rosa CM, Peter C, Guillermo CL, Marco C, Elsa C, Carpenter K, Castaño-León Ana M, Francesco C, Giorgio C, Arturo C, Giuseppe C, Maryse C, Mark C, Jonathan C, Lizzie CK, Johnny C, Cooper Jamie D, Marta C, Amra C, Nicola C, Endre C, Marek C, Claire DF, François D, Pierre D, Helen D, Véronique K, Francesco DC, Bart D, de Ruiter Godard CW, Dula D, Shenghao D, Diederik D, Abhishek D, Emma D, Jens D, Guy-Loup D, George E, Heiko E, Ari E, Patrick E, Erzsébet E, Martin F, Feigin Valery L, Junfeng F, Kelly F, Francesca F, Gilles F, Ulderico F, Shirin F, Alex F, Pablo G, Damien G, Dashiell G, Guoyi G, Karin G, Pradeep G, Alexandre G, Lelde G, Benoit G, Ben G, Jagos G, Gomez Pedro A, Francesca G, Gruen Russell L, Deepak G, Haagsma Juanita A, Iain H, Hartings Jed A, Raimund H, Eirik H, Daniel H, Astrid H, Stefan H, Lindsay H, Jilske H, Hutchinson Peter J, Kristine HA, Bram J, Stefan J, Mike J, Bojan J, Ji-Yao J, Kelly J, Konstantinos K, Mladen K, Ari K, Maija K, Thomas K, Riku K, Kolias Angelos G, Bálint K, Erwin K, Ksenija K, Daniel K, Lars-Owe K, Noémi K, Alfonso L, Linda L, Steven L, Fiona L, Christian L, Rolf L, Valerie L, Jin L, Leon L, Roger L, Hester L, Dirk L, Angels L, Maas Andrew IR, Stephen M, Marc M, Marek M, Sebastian M, Alex M, Geoffrey M, Didier M, Francisco ML, Costanza M, Armando M, Hugues M, Alessandro M, Julia M, Charles M, Catherine M, Béla M, David M, Tomas M, Cristina MK, Davide M, Visakh M, Lynnette M, Holger M, Nandesh N, Ancuta N, David N, Virginia N, Daan N, Quentin N, József N, Mauro O, Annemarie O, Matej O, Fabrizio O, Aarno P, Parizel Paul M, Adriana P, Jean-François P, Natascha P, Vincent P, Paolo P, Wilco P, Anna PK, Sébastien PF, Matti P, Horia P, Antonia PM, Suzanne P, Inigo P, Jussi P, Louis P, Andreea R, Arminas R, Rahul R, Malinka R, Ruben R, Veronika R, Jonathan R, Samuli R, Saulius R, Cecilie R, Olav R, Gerwin R, Jonathan R, Jeffrey R, Christina R, Guy R, Rolf R, Sandra R, Daniel R, Martin R, Marco S, Barbara S, Juan S, Oliver S, Francesca S, Renan SP, Janos S, Edgar S, Luminita S, Davide S, Nadine S, Inger S, Barbara S, Silke S, Herbert S, Guus S, Frederik SR, Elisabeth S, Michael S, Özcan S, Toril S, Lidwien S, Dirk S, Peter S, Abayomi S, Emmanuel S, Simon S, Nicole S, Ana S, Robert S, William S, Steyerberg Ewout W, Nino S, Nina S, Anneliese S, Silvio TF, Riikka T, Viktória T, Päivi T, Steven TM, Braden TA, Olli T, Ralph T, Guido T, Alice T, Matt T, Dick T, Christos T, Luaba TJ, Tony T, Maria TC, Peter V, Shirley V, Egils V, der Steen Gregory V, van der Mathieu J, van der Joukje N, van Dijck Jeroen TJM, van Essen Thomas A, Wim VH, van Caroline H, Dominique VP, Thijs VV, Julia VW, Audrey V, Alessia V, Emmanuel V, Kimberley V, Jan V, Vespa Paul M, Anne V, Rimantas V, Giacinta V, Carmen VL, Victor V, Daphne V, Peter V, Zoltán V, Derick W, Wang Kevin KW, Lei W, Lars W, Eno W, Guy W, Lindsay W, Winkler Maren KL, Stefan W, Peter Y, Alexander Y, Menashe Z, Yang Z, Agate Z, Fabrizio Z.

Author information

1
Department of Neurosurgery, Leiden University Medical Center, University Neurosurgical Center Holland (UNCH), Leiden, The Netherlands. essen@lumc.nl.
2
Department of Neurosurgery, Haaglanden Medical Center, University Neurosurgical Center Holland (UNCH), The Hague, The Netherlands. essen@lumc.nl.
3
Department of Neurosurgery, Radboud University Medical Center, Nijmegen, The Netherlands.
4
Center for Medical Decision Sciences, Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
5
Department of Neurosurgery, Haaglanden Medical Center, University Neurosurgical Center Holland (UNCH), The Hague, The Netherlands.
6
Department of Neurosurgery, Erasmus Medical Center, Rotterdam, The Netherlands.
7
Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands.
8
Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
9
Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium.
10
Department of Neurosurgery, Leiden University Medical Center, University Neurosurgical Center Holland (UNCH), Leiden, The Netherlands.

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.

KEYWORDS:

Acute subdural hematoma; Neurosurgery; Practice variation; Traumatic brain injury

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