Victor Volovici1, Ari Ercole2, Giuseppe Citerio3, Nino Stocchetti4, Iain K Haitsma5, Jilske A Huijben6, Clemens M F Dirven5, Mathieu van der Jagt7, Ewout W Steyerberg8, David Nelson9, Maryse C Cnossen6, Andrew I R Maas10, Suzanne Polinder6, David K Menon2, Hester F Lingsma6. 1. Department of Neurosurgery, Erasmus MC, Rotterdam, the Netherlands; Center for Medical Decision Making, Department of Public Health, Erasmus MC, Rotterdam, the Netherlands. Electronic address: v.volovici@erasmusmc.nl. 2. Division of Anesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK. 3. School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy; Neurointensive Care Unit, San Gerardo Hospital, ASST-Monza, Monza, Italy. 4. Department of Pathophysiology and Transplants, University of Milan, Milan, Italy; Department of Anesthesia and Critical Care, Neuroscience Intensive Care Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy. 5. Department of Neurosurgery, Erasmus MC, Rotterdam, the Netherlands. 6. Center for Medical Decision Making, Department of Public Health, Erasmus MC, Rotterdam, the Netherlands. 7. Department of Intensive Care Adults, Erasmus MC, Rotterdam, the Netherlands. 8. Center for Medical Decision Making, Department of Public Health, Erasmus MC, Rotterdam, the Netherlands; Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands. 9. Department of Physiology and Pharmacology, Section of Perioperative Medicine and Intensive Care, Karolinska Institutet, Stockholm, Sweden. 10. Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium.
Abstract
OBJECTIVE: Guidelines may reduce practice variation and optimize patient care. We aimed to study differences in guideline use in the management of traumatic brain injury (TBI) patients and analyze reasons for guideline non-adherence. METHODS: As part of a prospective, observational, multicenter European cohort study, participants from 68 centers in 20 countries were asked to complete 72-item questionnaires regarding their management of severe TBI. Six questions with multiple sub-questions focused on guideline use and implementation. RESULTS: Questionnaires were completed by 65 centers. Of these, 49 (75%) reported use of the Brain Trauma Foundation guidelines for the medical management of TBI or related institutional protocols, 11 (17%) used no guidelines, and 5 used other guidelines (8%). Of 54 centers reporting use of any guidelines, 41 (75%) relied on written guidelines. Four centers of the 54 (7%) reported no formal implementation efforts. Structural attention to the guidelines during daily clinical rounds was reported by 21 centers (38%). The most often reported reasons for non-adherence were "every patient is unique" and the presence of extracranial injuries, both for centers that did and did not report the use of guidelines. CONCLUSIONS: There is substantial variability in the use and implementation of guidelines in neurotrauma centers in Europe. Further research is needed to strengthen the evidence underlying guidelines and to overcome implementation barriers.
OBJECTIVE: Guidelines may reduce practice variation and optimize patient care. We aimed to study differences in guideline use in the management of traumatic brain injury (TBI) patients and analyze reasons for guideline non-adherence. METHODS: As part of a prospective, observational, multicenter European cohort study, participants from 68 centers in 20 countries were asked to complete 72-item questionnaires regarding their management of severe TBI. Six questions with multiple sub-questions focused on guideline use and implementation. RESULTS: Questionnaires were completed by 65 centers. Of these, 49 (75%) reported use of the Brain Trauma Foundation guidelines for the medical management of TBI or related institutional protocols, 11 (17%) used no guidelines, and 5 used other guidelines (8%). Of 54 centers reporting use of any guidelines, 41 (75%) relied on written guidelines. Four centers of the 54 (7%) reported no formal implementation efforts. Structural attention to the guidelines during daily clinical rounds was reported by 21 centers (38%). The most often reported reasons for non-adherence were "every patient is unique" and the presence of extracranial injuries, both for centers that did and did not report the use of guidelines. CONCLUSIONS: There is substantial variability in the use and implementation of guidelines in neurotrauma centers in Europe. Further research is needed to strengthen the evidence underlying guidelines and to overcome implementation barriers.
Authors: Cassidy Q B Mostert; Ranjit D Singh; Maxime Gerritsen; Erwin J O Kompanje; Gerard M Ribbers; Wilco C Peul; Jeroen T J M van Dijck Journal: Acta Neurochir (Wien) Date: 2022-01-31 Impact factor: 2.816
Authors: Victor Volovici; Dana Pisică; Benjamin Y Gravesteijn; Clemens M F Dirven; Ewout W Steyerberg; Ari Ercole; Nino Stocchetti; David Nelson; David K Menon; Giuseppe Citerio; Mathieu van der Jagt; Andrew I R Maas; Iain K Haitsma; Hester F Lingsma Journal: Acta Neurochir (Wien) Date: 2022-06-01 Impact factor: 2.816