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 language | English (US) |
|---|---|
| Pages (from-to) | 435-449 |
| Number of pages | 15 |
| Journal | Acta Neurochirurgica |
| Volume | 161 |
| Issue number | 3 |
| DOIs | |
| State | Published - Mar 13 2019 |
| Externally published | Yes |
Keywords
- Acute subdural hematoma
- Neurosurgery
- Practice variation
- Traumatic brain injury
ASJC Scopus subject areas
- Surgery
- Clinical Neurology
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Variation in neurosurgical management of traumatic brain injury : a survey in 68 centers participating in the CENTER-TBI study. / van Essen, Thomas A.; Den Boogert, Hugo F.; Cnossen, Maryse C.; de Ruiter, Godard C.W.; Haitsma, Iain; Polinder, Suzanne; Steyerberg, Ewout W.; Menon, David; Maas, Andrew I.R.; Lingsma, Hester F.; Peul, Wilco C.; Cecilia, Ackerlund; Hadie, Adams; Vanni, Agnoletti; Judith, Allanson; Krisztina, Amrein; Norberto, Andaluz; Nada, Andelic; Lasse, Andreassen; Azasevac, Antun; Audny, Anke; Anna, Antoni; Hilko, Ardon; Gérard, Audibert; Kaspars, Auslands; Philippe, Azouvi; Luisa, Azzolini Maria; Camelia, Baciu; Rafael, Badenes; Ronald, Bartels; Pál, Barzó; Ursula, Bauerfeind; Romuald, Beauvais; Ronny, Beer; Javier, Belda Francisco; Bo-Michael, Bellander; Antonio, Belli; Rémy, Bellier; Habib, Benali; Thierry, Benard; Maurizio, Berardino; Luigi, Beretta; Christopher, Beynon; Federico, Bilotta; Harald, Binder; Erta, Biqiri; Morten, Blaabjerg; Hugo, Boogert; Pierre, Bouzat; Peter, Bragge; Alexandra, Brazinova; Vibeke, Brinck; Joanne, Brooker; Camilla, Brorsson; Andras, Buki; Monika, Bullinger; Emiliana, Calappi; Rosa, Calvi Maria; Peter, Cameron; Guillermo, Carbayo Lozano; Marco, Carbonara; Elsa, Carise; Carpenter, K.; Castaño-León, Ana M.; Francesco, Causin; Giorgio, Chevallard; Arturo, Chieregato; Giuseppe, Citerio; Maryse, Cnossen; Mark, Coburn; Jonathan, Coles; Lizzie, Coles Kemp; Johnny, Collett; Cooper, Jamie D.; Marta, Correia; Amra, Covic; Nicola, Curry; Endre, Czeiter; Marek, Czosnyka; Claire, Dahyot Fizelier; François, Damas; Pierre, Damas; Helen, Dawes; Véronique, De Keyser; Francesco, Della Corte; Bart, Depreitere; de Ruiter Godard, C. W.; Dula, Dilvesi; Shenghao, Ding; Diederik, Dippel; Abhishek, Dixit; Emma, Donoghue; Jens, Dreier; Guy-Loup, Dulière; George, Eapen; Heiko, Engemann; Ari, Ercole; Patrick, Esser; Erzsébet, Ezer; Martin, Fabricius; Feigin, Valery L.; Junfeng, Feng; Kelly, Foks; Francesca, Fossi; Gilles, Francony; Ulderico, Freo; Shirin, Frisvold; Alex, Furmanov; Pablo, Gagliardo; Damien, Galanaud; Dashiell, Gantner; Guoyi, Gao; Karin, Geleijns; Pradeep, George; Alexandre, Ghuysen; Lelde, Giga; Benoit, Giraud; Ben, Glocker; Jagos, Golubovic; Gomez, Pedro A.; Francesca, Grossi; Gruen, Russell L.; Deepak, Gupta; Haagsma, Juanita A.; Iain, Haitsma; Hartings, Jed A.; Raimund, Helbok; Eirik, Helseth; Daniel, Hertle; Astrid, Hoedemaekers; Stefan, Hoefer; Lindsay, Horton; Jilske, Huijben; Hutchinson, Peter J.; Kristine, Håberg Asta; Bram, Jacobs; Stefan, Jankowski; Mike, Jarrett; Bojan, Jelaca; Ji-Yao, Jiang; Kelly, Jones; Konstantinos, Kamnitsas; Mladen, Karan; Ari, Katila; Maija, Kaukonen; Thomas, Kerforne; Riku, Kivisaari; Kolias, Angelos G.; Bálint, Kolumbán; Erwin, Kompanje; Ksenija, Kolundzija; Daniel, Kondziella; Lars-Owe, Koskinen; Noémi, Kovács; Alfonso, Lagares; Linda, Lanyon; Steven, Laureys; Fiona, Lecky; Christian, Ledig; Rolf, Lefering; Valerie, Legrand; Jin, Lei; Leon, Levi; Roger, Lightfoot; Hester, Lingsma; Dirk, Loeckx; Angels, Lozano; Maas, Andrew I.R.; Stephen, Macdonald; Marc, Maegele; Marek, Majdan; Sebastian, Major; Alex, Manara; Geoffrey, Manley; Didier, Martin; Francisco, Martin Leon; Costanza, Martino; Armando, Maruenda; Hugues, Maréchal; Alessandro, Masala; Julia, Mattern; Charles, McFadyen; Catherine, McMahon; Béla, Melegh; David, Menon; Tomas, Menovsky; Cristina, Morganti Kossmann; Davide, Mulazzi; Visakh, Muraleedharan; Lynnette, Murray; Holger, Mühlan; Nandesh, Nair; Ancuta, Negru; David, Nelson; Virginia, Newcombe; Daan, Nieboer; Quentin, Noirhomme; József, Nyirádi; Mauro, Oddo; Annemarie, Oldenbeuving; Matej, Oresic; Fabrizio, Ortolano; Aarno, Palotie; Parizel, Paul M.; Adriana, Patruno; Jean-François, Payen; Natascha, Perera; Vincent, Perlbarg; Paolo, Persona; Wilco, Peul; Anna, Piippo Karjalainen; Sébastien, Pili Floury; Matti, Pirinen; Horia, Ples; Antonia, Poca Maria; Suzanne, Polinder; Inigo, Pomposo; Jussi, Posti; Louis, Puybasset; Andreea, Radoi; Arminas, Ragauskas; Rahul, Raj; Malinka, Rambadagalla; Ruben, Real; Veronika, Rehorčíková; Jonathan, Rhodes; Samuli, Ripatti; Saulius, Rocka; Cecilie, Roe; Olav, Roise; Gerwin, Roks; Jonathan, Rosand; Jeffrey, Rosenfeld; Christina, Rosenlund; Guy, Rosenthal; Rolf, Rossaint; Sandra, Rossi; Daniel, Rueckert; Martin, Rusnák; Marco, Sacchi; Barbara, Sahakian; Juan, Sahuquillo; Oliver, Sakowitz; Francesca, Sala; Renan, Sanchez Porras; Janos, Sandor; Edgar, Santos; Luminita, Sasu; Davide, Savo; Nadine, Schäffer; Inger, Schipper; Barbara, Schlößer; Silke, Schmidt; Herbert, Schoechl; Guus, Schoonman; Frederik, Schouico; Elisabeth, Schwendenwein; Michael, Schöll; Özcan, Sir; Toril, Skandsen; Lidwien, Smakman; Dirk, Smeets; Peter, Smielewski; Abayomi, Sorinola; Emmanuel, Stamatakis; Simon, Stanworth; Nicole, Steinbüchel; Ana, Stevanovic; Robert, Stevens; William, Stewart; Nino, Stocchetti; Nina, Sundström; Anneliese, Synnot; Silvio, Taccone Fabio; Riikka, Takala; Viktória, Tamás; Päivi, Tanskanen; Steven, Taylor Mark; Braden, Te Ao; Olli, Tenovuo; Ralph, Telgmann; Guido, Teodorani; Alice, Theadom; Matt, Thomas; Dick, Tibboel; Christos, Tolias; Luaba, Tshibanda Jean Flory; Tony, Trapani; Maria, Tudora Cristina; Peter, Vajkoczy; Shirley, Vallance; Egils, Valeinis; Gregory, Van der Steen; Mathieu, van der Jagt; Joukje, van der Naalt; van Dijck, Jeroen T.J.M.; van Essen, Thomas A.; Van Hecke, Wim; van Heugten, Caroline; Van Praag, Dominique; Thijs, Vande Vyvere; Julia, Van Waesberghe; Audrey, Vanhaudenhuyse; Alessia, Vargiolu; Emmanuel, Vega; Kimberley, Velt; Jan, Verheyden; Vespa, Paul M.; Anne, Vik; Rimantas, Vilcinis; Giacinta, Vizzino; Carmen, Vl Eggeert Lankamp; Victor, Volovici; Daphne, Voormolen; Peter, Vulekovic; Zoltán, Vámos; Derick, Wade; Wang, Kevin K.W.; Lei, Wang; Lars, Wessels; Eno, Wildschut; Guy, Williams; Lindsay, Wilson; Winkler, Maren K.L.; Stefan, Wolf; Peter, Ylén; Alexander, Younsi; Menashe, Zaaroor; Yang, Zhihui; Agate, Ziverte; Fabrizio, Zumbo.
In: Acta Neurochirurgica, Vol. 161, No. 3, 13.03.2019, p. 435-449.Research output: Contribution to journal › Article › peer-review
}
TY - JOUR
T1 - Variation in neurosurgical management of traumatic brain injury
T2 - a survey in 68 centers participating in the CENTER-TBI study
AU - van Essen, Thomas A.
AU - Den Boogert, Hugo F.
AU - Cnossen, Maryse C.
AU - de Ruiter, Godard C.W.
AU - Haitsma, Iain
AU - Polinder, Suzanne
AU - Steyerberg, Ewout W.
AU - Menon, David
AU - Maas, Andrew I.R.
AU - Lingsma, Hester F.
AU - Peul, Wilco C.
AU - Cecilia, Ackerlund
AU - Hadie, Adams
AU - Vanni, Agnoletti
AU - Judith, Allanson
AU - Krisztina, Amrein
AU - Norberto, Andaluz
AU - Nada, Andelic
AU - Lasse, Andreassen
AU - Azasevac, Antun
AU - Audny, Anke
AU - Anna, Antoni
AU - Hilko, Ardon
AU - Gérard, Audibert
AU - Kaspars, Auslands
AU - Philippe, Azouvi
AU - Luisa, Azzolini Maria
AU - Camelia, Baciu
AU - Rafael, Badenes
AU - Ronald, Bartels
AU - Pál, Barzó
AU - Ursula, Bauerfeind
AU - Romuald, Beauvais
AU - Ronny, Beer
AU - Javier, Belda Francisco
AU - Bo-Michael, Bellander
AU - Antonio, Belli
AU - Rémy, Bellier
AU - Habib, Benali
AU - Thierry, Benard
AU - Maurizio, Berardino
AU - Luigi, Beretta
AU - Christopher, Beynon
AU - Federico, Bilotta
AU - Harald, Binder
AU - Erta, Biqiri
AU - Morten, Blaabjerg
AU - Hugo, Boogert
AU - Pierre, Bouzat
AU - Peter, Bragge
AU - Alexandra, Brazinova
AU - Vibeke, Brinck
AU - Joanne, Brooker
AU - Camilla, Brorsson
AU - Andras, Buki
AU - Monika, Bullinger
AU - Emiliana, Calappi
AU - Rosa, Calvi Maria
AU - Peter, Cameron
AU - Guillermo, Carbayo Lozano
AU - Marco, Carbonara
AU - Elsa, Carise
AU - Carpenter, K.
AU - Castaño-León, Ana M.
AU - Francesco, Causin
AU - Giorgio, Chevallard
AU - Arturo, Chieregato
AU - Giuseppe, Citerio
AU - Maryse, Cnossen
AU - Mark, Coburn
AU - Jonathan, Coles
AU - Lizzie, Coles Kemp
AU - Johnny, Collett
AU - Cooper, Jamie D.
AU - Marta, Correia
AU - Amra, Covic
AU - Nicola, Curry
AU - Endre, Czeiter
AU - Marek, Czosnyka
AU - Claire, Dahyot Fizelier
AU - François, Damas
AU - Pierre, Damas
AU - Helen, Dawes
AU - Véronique, De Keyser
AU - Francesco, Della Corte
AU - Bart, Depreitere
AU - de Ruiter Godard, C. W.
AU - Dula, Dilvesi
AU - Shenghao, Ding
AU - Diederik, Dippel
AU - Abhishek, Dixit
AU - Emma, Donoghue
AU - Jens, Dreier
AU - Guy-Loup, Dulière
AU - George, Eapen
AU - Heiko, Engemann
AU - Ari, Ercole
AU - Patrick, Esser
AU - Erzsébet, Ezer
AU - Martin, Fabricius
AU - Feigin, Valery L.
AU - Junfeng, Feng
AU - Kelly, Foks
AU - Francesca, Fossi
AU - Gilles, Francony
AU - Ulderico, Freo
AU - Shirin, Frisvold
AU - Alex, Furmanov
AU - Pablo, Gagliardo
AU - Damien, Galanaud
AU - Dashiell, Gantner
AU - Guoyi, Gao
AU - Karin, Geleijns
AU - Pradeep, George
AU - Alexandre, Ghuysen
AU - Lelde, Giga
AU - Benoit, Giraud
AU - Ben, Glocker
AU - Jagos, Golubovic
AU - Gomez, Pedro A.
AU - Francesca, Grossi
AU - Gruen, Russell L.
AU - Deepak, Gupta
AU - Haagsma, Juanita A.
AU - Iain, Haitsma
AU - Hartings, Jed A.
AU - Raimund, Helbok
AU - Eirik, Helseth
AU - Daniel, Hertle
AU - Astrid, Hoedemaekers
AU - Stefan, Hoefer
AU - Lindsay, Horton
AU - Jilske, Huijben
AU - Hutchinson, Peter J.
AU - Kristine, Håberg Asta
AU - Bram, Jacobs
AU - Stefan, Jankowski
AU - Mike, Jarrett
AU - Bojan, Jelaca
AU - Ji-Yao, Jiang
AU - Kelly, Jones
AU - Konstantinos, Kamnitsas
AU - Mladen, Karan
AU - Ari, Katila
AU - Maija, Kaukonen
AU - Thomas, Kerforne
AU - Riku, Kivisaari
AU - Kolias, Angelos G.
AU - Bálint, Kolumbán
AU - Erwin, Kompanje
AU - Ksenija, Kolundzija
AU - Daniel, Kondziella
AU - Lars-Owe, Koskinen
AU - Noémi, Kovács
AU - Alfonso, Lagares
AU - Linda, Lanyon
AU - Steven, Laureys
AU - Fiona, Lecky
AU - Christian, Ledig
AU - Rolf, Lefering
AU - Valerie, Legrand
AU - Jin, Lei
AU - Leon, Levi
AU - Roger, Lightfoot
AU - Hester, Lingsma
AU - Dirk, Loeckx
AU - Angels, Lozano
AU - Maas, Andrew I.R.
AU - Stephen, Macdonald
AU - Marc, Maegele
AU - Marek, Majdan
AU - Sebastian, Major
AU - Alex, Manara
AU - Geoffrey, Manley
AU - Didier, Martin
AU - Francisco, Martin Leon
AU - Costanza, Martino
AU - Armando, Maruenda
AU - Hugues, Maréchal
AU - Alessandro, Masala
AU - Julia, Mattern
AU - Charles, McFadyen
AU - Catherine, McMahon
AU - Béla, Melegh
AU - David, Menon
AU - Tomas, Menovsky
AU - Cristina, Morganti Kossmann
AU - Davide, Mulazzi
AU - Visakh, Muraleedharan
AU - Lynnette, Murray
AU - Holger, Mühlan
AU - Nandesh, Nair
AU - Ancuta, Negru
AU - David, Nelson
AU - Virginia, Newcombe
AU - Daan, Nieboer
AU - Quentin, Noirhomme
AU - József, Nyirádi
AU - Mauro, Oddo
AU - Annemarie, Oldenbeuving
AU - Matej, Oresic
AU - Fabrizio, Ortolano
AU - Aarno, Palotie
AU - Parizel, Paul M.
AU - Adriana, Patruno
AU - Jean-François, Payen
AU - Natascha, Perera
AU - Vincent, Perlbarg
AU - Paolo, Persona
AU - Wilco, Peul
AU - Anna, Piippo Karjalainen
AU - Sébastien, Pili Floury
AU - Matti, Pirinen
AU - Horia, Ples
AU - Antonia, Poca Maria
AU - Suzanne, Polinder
AU - Inigo, Pomposo
AU - Jussi, Posti
AU - Louis, Puybasset
AU - Andreea, Radoi
AU - Arminas, Ragauskas
AU - Rahul, Raj
AU - Malinka, Rambadagalla
AU - Ruben, Real
AU - Veronika, Rehorčíková
AU - Jonathan, Rhodes
AU - Samuli, Ripatti
AU - Saulius, Rocka
AU - Cecilie, Roe
AU - Olav, Roise
AU - Gerwin, Roks
AU - Jonathan, Rosand
AU - Jeffrey, Rosenfeld
AU - Christina, Rosenlund
AU - Guy, Rosenthal
AU - Rolf, Rossaint
AU - Sandra, Rossi
AU - Daniel, Rueckert
AU - Martin, Rusnák
AU - Marco, Sacchi
AU - Barbara, Sahakian
AU - Juan, Sahuquillo
AU - Oliver, Sakowitz
AU - Francesca, Sala
AU - Renan, Sanchez Porras
AU - Janos, Sandor
AU - Edgar, Santos
AU - Luminita, Sasu
AU - Davide, Savo
AU - Nadine, Schäffer
AU - Inger, Schipper
AU - Barbara, Schlößer
AU - Silke, Schmidt
AU - Herbert, Schoechl
AU - Guus, Schoonman
AU - Frederik, Schouico
AU - Elisabeth, Schwendenwein
AU - Michael, Schöll
AU - Özcan, Sir
AU - Toril, Skandsen
AU - Lidwien, Smakman
AU - Dirk, Smeets
AU - Peter, Smielewski
AU - Abayomi, Sorinola
AU - Emmanuel, Stamatakis
AU - Simon, Stanworth
AU - Nicole, Steinbüchel
AU - Ana, Stevanovic
AU - Robert, Stevens
AU - William, Stewart
AU - Nino, Stocchetti
AU - Nina, Sundström
AU - Anneliese, Synnot
AU - Silvio, Taccone Fabio
AU - Riikka, Takala
AU - Viktória, Tamás
AU - Päivi, Tanskanen
AU - Steven, Taylor Mark
AU - Braden, Te Ao
AU - Olli, Tenovuo
AU - Ralph, Telgmann
AU - Guido, Teodorani
AU - Alice, Theadom
AU - Matt, Thomas
AU - Dick, Tibboel
AU - Christos, Tolias
AU - Luaba, Tshibanda Jean Flory
AU - Tony, Trapani
AU - Maria, Tudora Cristina
AU - Peter, Vajkoczy
AU - Shirley, Vallance
AU - Egils, Valeinis
AU - Gregory, Van der Steen
AU - Mathieu, van der Jagt
AU - Joukje, van der Naalt
AU - van Dijck, Jeroen T.J.M.
AU - van Essen, Thomas A.
AU - Van Hecke, Wim
AU - van Heugten, Caroline
AU - Van Praag, Dominique
AU - Thijs, Vande Vyvere
AU - Julia, Van Waesberghe
AU - Audrey, Vanhaudenhuyse
AU - Alessia, Vargiolu
AU - Emmanuel, Vega
AU - Kimberley, Velt
AU - Jan, Verheyden
AU - Vespa, Paul M.
AU - Anne, Vik
AU - Rimantas, Vilcinis
AU - Giacinta, Vizzino
AU - Carmen, Vl Eggeert Lankamp
AU - Victor, Volovici
AU - Daphne, Voormolen
AU - Peter, Vulekovic
AU - Zoltán, Vámos
AU - Derick, Wade
AU - Wang, Kevin K.W.
AU - Lei, Wang
AU - Lars, Wessels
AU - Eno, Wildschut
AU - Guy, Williams
AU - Lindsay, Wilson
AU - Winkler, Maren K.L.
AU - Stefan, Wolf
AU - Peter, Ylén
AU - Alexander, Younsi
AU - Menashe, Zaaroor
AU - Yang, Zhihui
AU - Agate, Ziverte
AU - Fabrizio, Zumbo
N1 - Funding Information: Funding/sponsors This study was funded by the European Union Seventh Framework Program (grant 602150) for Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) and the Hersenstichting Nederland (Dutch Brain Foundation, grant PS2014-06) for The Dutch Neurotraumatology Quality Registry (Net-QuRe). There is no industry affiliation. Funding Information: 53 Institute of Medical Psychology and Medical Sociology, Universitätsmedizin Göttingen, Göttingen, Germany. 54 Oxford University Hospitals NHS Trust, Oxford, UK. 55 Department of Neurosurgery, University of Pecs and MTA-PTE Clinical Neuroscience MR Research Group and Janos Szentagothai Research Centre, University of Pecs, Hungarian Brain Research Program (Grant No. KTIA 13 NAP-A-II/8), Pecs, Hungary. 56Brain Physics Lab, Division of Neurosurgery, Dept of Clinical Neurosciences, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK. 57 Intensive Care Unit, CHR Citadelle, Liège, Belgium. 58 Intensive Care Unit, CHU, Liège, Belgium. 59 Movement Science Group, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK. 60 Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium. 61 Department of Anesthesia & Intensive Care, Maggiore Della Carità Hospital, Novara, Italy. 62 Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium. 63 Dept. of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands and Dept. of Neurosurgery, Medical Center Haaglanden, The Hague, The Netherlands. 64 Department of Neurosurgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China. 65 Department of Neurology, Erasmus MC, Rotterdam, the Netherlands. 66 Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK. 67 Neurologie, Neurochirurgie und Psychiatrie, Charité – Universitätsmedizin Berlin, Berlin, Germany. 68 Neurointensive Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK. 69Department of Anaesthesiology and Intensive Therapy, University of Pécs, Pécs, Hungary. 70 Departments of Neurology, Clinical Neurophysiology and Neuroanesthesiology, Region Hovedstaden Rigshospitalet, Copenhagen, Denmark. 71National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand. 72 Department of Medicine, Azienda Ospedaliera Università di Padova, Padova, Italy. 73 Department of Anesthesiology and Intensive care, University Hospital Northern Norway, Tromso, Norway. 74 Department of Neurosurgery, Hadassah-hebrew University Medical center, Jerusalem, Israel. 75 Fundación Instituto Valenciano de Neurorrehabilitación (FIVAN), Valencia, Spain. 76Department of Neurosurgery, Shanghai Renji hospital, Shanghai Jiaotong University/school of medicine, Shanghai, China. Publisher Copyright: © 2018, The Author(s).
PY - 2019/3/13
Y1 - 2019/3/13
N2 - 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.
AB - 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.
KW - Acute subdural hematoma
KW - Neurosurgery
KW - Practice variation
KW - Traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=85058948585&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85058948585&partnerID=8YFLogxK
U2 - 10.1007/s00701-018-3761-z
DO - 10.1007/s00701-018-3761-z
M3 - Article
C2 - 30569224
AN - SCOPUS:85058948585
VL - 161
SP - 435
EP - 449
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
SN - 0001-6268
IS - 3
ER -