TY - JOUR
T1 - Variation in neurosurgical management of traumatic brain injury
T2 - a survey in 68 centers participating in the CENTER-TBI study
AU - on behalf of the CENTER-TBI Investigators and Participants
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 - den Hugo, Boogert
AU - Pierre, Bouzat
AU - Lindsay, Horton
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.
Funding Information:
77 Emergency Department, CHU, Liège, Belgium. 78 Pauls Stradins Clinical University Hospital, Riga, Latvia. 79 Department of Computing, Imperial College London, London, UK. 80 Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore; and Monash University, Australia. 81 Department of Neurosurgery, Neurosciences Centre & JPN Apex trauma centre, All India Institute of Medical Sciences, New Delhi-110,029, India. 82 Department of Neurosurgery, Erasmus MC, Rotterdam, the Netherlands. 83 Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA. 84 Department of Neurosurgery, Oslo University Hospital, Oslo, Norway. 85 Department of Intensive Care Medicine, Radboud University Medical Center. 86 Division of Psychology, University of Stirling, Stirling, UK. 87 Department of Medical Imaging, St. Olavs Hospital and Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway. 88 Department of Neurology, University Medical Center Groningen, Groningen, Netherlands. 89 National Institute for Stroke & Applied Neurosciences of the AUT University, Auckland, New Zealand. 90 Rehabilitation and Brain Trauma, Turku University Central Hospital and University of Turku, Turku, Finland. 91 Helsinki University Central Hospital. 92 Hungarian Brain Research Program - Grant No. KTIA 13 NAP-A-II/8, University of Pécs, Pécs, Hungary. 93 Department of Intensive Care and Department of Ethics and Philosophy of Medicine, Erasmus Medical Center, Rotterdam, The Netherlands. 94 Department of Psichiatry, Clinical centre of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia. 95 Cyclotron Research Center, University of Liège, Liège, Belgium. 96 Emergency Medicine Research in Sheffield, Health Services Research Section, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK. 97 Institute of Research in Operative Medicine (IFOM), Witten/Herdecke University, Cologne, Germany. 98 VP Global Project Management CNS, ICON, Paris, France. 99 Department of Neurosurgery, Rambam Medical Center, Haifa, Israel. 100 Department of Anesthesiology & Intensive Care, University Hospitals Southhampton NHS Trust, Southhampton, UK.
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
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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 -