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

Thomas A. van Essen, Hugo F. Den Boogert, Maryse C. Cnossen, Godard C.W. de Ruiter, Iain Haitsma, Suzanne Polinder, Ewout W. Steyerberg, David Menon, Andrew I.R. Maas, Hester F. Lingsma, Wilco C. Peul, Ackerlund Cecilia, Adams Hadie, Agnoletti Vanni, Allanson Judith, Amrein Krisztina, Andaluz Norberto, Andelic Nada, Andreassen Lasse, Antun AzasevacAnke Audny, Antoni Anna, Ardon Hilko, Audibert Gérard, Auslands Kaspars, Azouvi Philippe, Azzolini Maria Luisa, Baciu Camelia, Badenes Rafael, Bartels Ronald, Barzó Pál, Bauerfeind Ursula, Beauvais Romuald, Beer Ronny, Belda Francisco Javier, Bellander Bo-Michael, Belli Antonio, Bellier Rémy, Benali Habib, Benard Thierry, Berardino Maurizio, Beretta Luigi, Beynon Christopher, Bilotta Federico, Binder Harald, Biqiri Erta, Blaabjerg Morten, Boogert Hugo, Bouzat Pierre, Bragge Peter, Brazinova Alexandra, Brinck Vibeke, Brooker Joanne, Brorsson Camilla, Buki Andras, Bullinger Monika, Calappi Emiliana, Calvi Maria Rosa, Cameron Peter, Carbayo Lozano Guillermo, Carbonara Marco, Carise Elsa, K. Carpenter, Ana M. Castaño-León, Causin Francesco, Chevallard Giorgio, Chieregato Arturo, Citerio Giuseppe, Cnossen Maryse, Coburn Mark, Coles Jonathan, Coles Kemp Lizzie, Collett Johnny, Jamie D. Cooper, Correia Marta, Covic Amra, Curry Nicola, Czeiter Endre, Czosnyka Marek, Dahyot Fizelier Claire, Damas François, Damas Pierre, Dawes Helen, De Keyser Véronique, Della Corte Francesco, Depreitere Bart, C. W. de Ruiter Godard, Dilvesi Dula, Ding Shenghao, Dippel Diederik, Dixit Abhishek, Donoghue Emma, Dreier Jens, Dulière Guy-Loup, Eapen George, Engemann Heiko, Ercole Ari, Esser Patrick, Ezer Erzsébet, Fabricius Martin, Valery L. Feigin, Feng Junfeng, Foks Kelly, Fossi Francesca, Francony Gilles, Freo Ulderico, Frisvold Shirin, Furmanov Alex, Gagliardo Pablo, Galanaud Damien, Gantner Dashiell, Gao Guoyi, Geleijns Karin, George Pradeep, Ghuysen Alexandre, Giga Lelde, Giraud Benoit, Glocker Ben, Golubovic Jagos, Pedro A. Gomez, Grossi Francesca, Russell L. Gruen, Gupta Deepak, Juanita A. Haagsma, Haitsma Iain, Jed A. Hartings, Helbok Raimund, Helseth Eirik, Hertle Daniel, Hoedemaekers Astrid, Hoefer Stefan, Horton Lindsay, Huijben Jilske, Peter J. Hutchinson, Håberg Asta Kristine, Jacobs Bram, Jankowski Stefan, Jarrett Mike, Jelaca Bojan, Jiang Ji-Yao, Jones Kelly, Kamnitsas Konstantinos, Karan Mladen, Katila Ari, Kaukonen Maija, Kerforne Thomas, Kivisaari Riku, Angelos G. Kolias, Kolumbán Bálint, Kompanje Erwin, Kolundzija Ksenija, Kondziella Daniel, Koskinen Lars-Owe, Kovács Noémi, Lagares Alfonso, Lanyon Linda, Laureys Steven, Lecky Fiona, Ledig Christian, Lefering Rolf, Legrand Valerie, Lei Jin, Levi Leon, Lightfoot Roger, Lingsma Hester, Loeckx Dirk, Lozano Angels, Andrew I.R. Maas, Macdonald Stephen, Maegele Marc, Majdan Marek, Major Sebastian, Manara Alex, Manley Geoffrey, Martin Didier, Martin Leon Francisco, Martino Costanza, Maruenda Armando, Maréchal Hugues, Masala Alessandro, Mattern Julia, McFadyen Charles, McMahon Catherine, Melegh Béla, Menon David, Menovsky Tomas, Morganti Kossmann Cristina, Mulazzi Davide, Muraleedharan Visakh, Murray Lynnette, Mühlan Holger, Nair Nandesh, Negru Ancuta, Nelson David, Newcombe Virginia, Nieboer Daan, Noirhomme Quentin, Nyirádi József, Oddo Mauro, Oldenbeuving Annemarie, Oresic Matej, Ortolano Fabrizio, Palotie Aarno, Paul M. Parizel, Patruno Adriana, Payen Jean-François, Perera Natascha, Perlbarg Vincent, Persona Paolo, Peul Wilco, Piippo Karjalainen Anna, Pili Floury Sébastien, Pirinen Matti, Ples Horia, Poca Maria Antonia, Polinder Suzanne, Pomposo Inigo, Posti Jussi, Puybasset Louis, Radoi Andreea, Ragauskas Arminas, Raj Rahul, Rambadagalla Malinka, Real Ruben, Rehorčíková Veronika, Rhodes Jonathan, Ripatti Samuli, Rocka Saulius, Roe Cecilie, Roise Olav, Roks Gerwin, Rosand Jonathan, Rosenfeld Jeffrey, Rosenlund Christina, Rosenthal Guy, Rossaint Rolf, Rossi Sandra, Rueckert Daniel, Rusnák Martin, Sacchi Marco, Sahakian Barbara, Sahuquillo Juan, Sakowitz Oliver, Sala Francesca, Sanchez Porras Renan, Sandor Janos, Santos Edgar, Sasu Luminita, Savo Davide, Schäffer Nadine, Schipper Inger, Schlößer Barbara, Schmidt Silke, Schoechl Herbert, Schoonman Guus, Schouico Frederik, Schwendenwein Elisabeth, Schöll Michael, Sir Özcan, Skandsen Toril, Smakman Lidwien, Smeets Dirk, Smielewski Peter, Sorinola Abayomi, Stamatakis Emmanuel, Stanworth Simon, Steinbüchel Nicole, Stevanovic Ana, Stevens Robert, Stewart William, Ewout W. Steyerberg, Stocchetti Nino, Sundström Nina, Synnot Anneliese, Taccone Fabio Silvio, Takala Riikka, Tamás Viktória, Tanskanen Päivi, Taylor Mark Steven, Te Ao Braden, Tenovuo Olli, Telgmann Ralph, Teodorani Guido, Theadom Alice, Thomas Matt, Tibboel Dick, Tolias Christos, Tshibanda Jean Flory Luaba, Trapani Tony, Tudora Cristina Maria, Vajkoczy Peter, Vallance Shirley, Valeinis Egils, Van der Steen Gregory, van der Jagt Mathieu, van der Naalt Joukje, Jeroen T.J.M. van Dijck, Thomas A. van Essen, Wim Van Hecke, Caroline van Heugten, Dominique Van Praag, Vande Vyvere Thijs, Van Waesberghe Julia, Vanhaudenhuyse Audrey, Vargiolu Alessia, Vega Emmanuel, Velt Kimberley, Verheyden Jan, Paul M. Vespa, Vik Anne, Vilcinis Rimantas, Vizzino Giacinta, Vl Eggeert Lankamp Carmen, Volovici Victor, Voormolen Daphne, Vulekovic Peter, Vámos Zoltán, Wade Derick, Kevin K.W. Wang, Wang Lei, Wessels Lars, Wildschut Eno, Williams Guy, Wilson Lindsay, Maren K.L. Winkler, Wolf Stefan, Ylén Peter, Younsi Alexander, Zaaroor Menashe, Zhihui Yang, Ziverte Agate, Zumbo Fabrizio

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)435-449
Number of pages15
JournalActa Neurochirurgica
Volume161
Issue number3
DOIs
StatePublished - Mar 13 2019

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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