John C Lee1, Katelyn Rittenhouse2, Katherine Bupp3, Brian Gross4, Amelia Rogers5, Frederick B Rogers6, Michael Horst7, Lisa Estrella8, James Thurmond9. 1. Trauma Services, Lancaster General Health,, 555 N, Duke Street, Lancaster, PA 17601, United States. Electronic address: jclee@lghealth.org. 2. Trauma Services, Lancaster General Health,, 555 N, Duke Street, Lancaster, PA 17601, United States. Electronic address: kr061@lghealth.org. 3. Trauma Services, Lancaster General Health,, 555 N, Duke Street, Lancaster, PA 17601, United States. Electronic address: kbupp2@lghealth.org. 4. Trauma Services, Lancaster General Health,, 555 N, Duke Street, Lancaster, PA 17601, United States. Electronic address: bg029@lghealth.org. 5. Trauma Services, Lancaster General Health,, 555 N, Duke Street, Lancaster, PA 17601, United States. Electronic address: atrogers89@gmail.com. 6. Trauma Services, Lancaster General Health,, 555 N, Duke Street, Lancaster, PA 17601, United States. Electronic address: frogers2@lghealth.org. 7. Trauma Services, Lancaster General Health,, 555 N, Duke Street, Lancaster, PA 17601, United States. Electronic address: mahorst@lghealth.org. 8. Trauma Services, Lancaster General Health,, 555 N, Duke Street, Lancaster, PA 17601, United States. Electronic address: lestrella2@lghealth.org. 9. Trauma Services, Lancaster General Health,, 555 N, Duke Street, Lancaster, PA 17601, United States. Electronic address: jthurmond2@lghealth.org.
Abstract
INTRODUCTION: Evidence-based guidelines for the care of severe traumatic brain injury have been available from the Brain Trauma Foundation (BTF) since 1995. A total of 15 recommendations compose the current guidelines. Although each individual guideline has been validated in isolation, to date, little research has examined the guidelines in composite. We examined the relationship between compliance with the BTF severe TBI guidelines and mortality. MATERIALS AND METHODS: In a Pennsylvania-verified, mature Level II trauma centre, patients with an admission Glasgow Coma Scale (GCS) ≤ 8 and an abnormal head CT from 2007 to 2012 were queried from the trauma registry. Exclusion criteria included: patients who sustained a non-survivable injury (AIS head 6), died ≤ 24 h, and/or were transferred to a paediatric trauma centre. Strict adherence to the BTF guidelines was determined in a binary fashion (yes/no). We then calculated each patient's percent compliance with total number of guidelines. Bivariate analysis was used to find significant predictors of mortality (p<0.05), including percent BTF guidelines compliance. Significant factors were added to a multivariable logistic regression model to look at mortality rates across the percent compliance spectrum. RESULTS: 185 Patients met inclusion criteria. Percent compliance ranged from 28.6% to 94.4%, (median=71.4%). Following adjustment for age, AIS head, and GCS motor, patients with 55-75% compliance (AOR: 0.20; 95%CI: 0.06-0.70) and >75% compliance (AOR: 0.27; 95%CI: 0.08-0.94) had reduced odds of mortality, as compared to <55% compliance to the BTF guidelines. When the unadjusted rate of mortality was compared across the compliance spectrum, the odds of mortality decreased as compliance increased until 75%, and then reversed. CONCLUSION: Our data indicate that full compliance with all 15 severe TBI guidelines is difficult to achieve and may not be necessary to optimally care for patients.
INTRODUCTION: Evidence-based guidelines for the care of severe traumatic brain injury have been available from the Brain Trauma Foundation (BTF) since 1995. A total of 15 recommendations compose the current guidelines. Although each individual guideline has been validated in isolation, to date, little research has examined the guidelines in composite. We examined the relationship between compliance with the BTF severe TBI guidelines and mortality. MATERIALS AND METHODS: In a Pennsylvania-verified, mature Level II trauma centre, patients with an admission Glasgow Coma Scale (GCS) ≤ 8 and an abnormal head CT from 2007 to 2012 were queried from the trauma registry. Exclusion criteria included: patients who sustained a non-survivable injury (AIS head 6), died ≤ 24 h, and/or were transferred to a paediatric trauma centre. Strict adherence to the BTF guidelines was determined in a binary fashion (yes/no). We then calculated each patient's percent compliance with total number of guidelines. Bivariate analysis was used to find significant predictors of mortality (p<0.05), including percent BTF guidelines compliance. Significant factors were added to a multivariable logistic regression model to look at mortality rates across the percent compliance spectrum. RESULTS: 185 Patients met inclusion criteria. Percent compliance ranged from 28.6% to 94.4%, (median=71.4%). Following adjustment for age, AIS head, and GCS motor, patients with 55-75% compliance (AOR: 0.20; 95%CI: 0.06-0.70) and >75% compliance (AOR: 0.27; 95%CI: 0.08-0.94) had reduced odds of mortality, as compared to <55% compliance to the BTF guidelines. When the unadjusted rate of mortality was compared across the compliance spectrum, the odds of mortality decreased as compliance increased until 75%, and then reversed. CONCLUSION: Our data indicate that full compliance with all 15 severe TBI guidelines is difficult to achieve and may not be necessary to optimally care for patients.
Authors: Anjni Patel; Mateus Mazorra Coelho Vieira; John Abraham; Nick Reid; Tu Tran; Kevin Tomecsek; João Ricardo N Vissoci; Stephanie Eucker; Charles J Gerardo; Catherine A Staton Journal: PLoS One Date: 2016-09-01 Impact factor: 3.240