Results of the study-survey on patient care in neurotrauma units

03 Ago Results of the study-survey on patient care in neurotrauma units

⇒ The study is part of the research line of the European network of expert professionals in the management of traumatic brain injury: Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) of which Dr. Armando Maruenda, Dr. Rafael Badenes and Dr. Javier Belda, from the Research Group in Anaesthesia of INCLIVA are members. ⇒ The results of the study have been published in the scientific journal Critical Care. The study aimed to assess the variation in professional perceptions of general supportive and preventive care policies for patients with traumatic brain injury in European neurotrauma centres. To this end, a survey was conducted as part of the CENTER-TBI study. Twenty-three questions were analyzed, focusing on: 1) circulatory and respiratory control; 2) fever control; 3) corticosteroid use; 4) nutrition and glucose control; and 5) seizure prophylaxis and treatment. Finally, data on patient characteristics, care and outcomes were collected from 66 health centres in 20 countries in Europe and Israel. All of these centres were asked to complete a «Professional Profile Questionnaire». European experts in the management of traumatic brain injury patients responded to the professional profile questionnaire that was developed in several stages. First, the literature was scanned for evidence, including available guidelines and surveys. Second, a pilot study was conducted in 16 participating centres to receive feedback, determine ambiguity and detect unexpected values. Throughout all stages, experts from various disciplines (neurosurgeons, intensivists, neurologists, emergency department physicians, rehabilitation physicians, medical ethicists, health economists and epidemiologists) were asked for advice on the development of the questionnaire. Previously, details of the development, administration and content of the complete professional profile questionnaires have been published. The survey reflects that practice preferences vary with respect to general support and prevention measures for patients with traumatic brain injury in the Intensive Care Units of European neurotrauma centres. These results provide an opportunity for future comparative research on efficacy, as evidence-based uniformity of good practice in overall ICU care could have a significant impact on the outcome of traumatic brain injury, the study indicates.

About traumatic brain injury

Traumatic brain injury (TBI) is one of the leading causes of death from trauma and hospital admissions in Europe. It is known as a complex heterogeneous syndrome. The increased vulnerability of this population is reflected in higher mortality rates in patients with traumatic brain injury compared to patients with non-cranial trauma. Therefore, severely injured patients require specialized neurointensive care or treatment in an intensive care unit (ICU). Mortality rates are high, ranging from 30% to 40% in unselected observational series. In addition, there are substantial differences between countries, including between centres, which could be partly explained by differences in treatment. The key objectives for the care of traumatic brain injury patients in the ICU are to maintain general physiology and prevent secondary brain injury. A number of brain-specific therapies, such as intracranial pressure-driven treatment or, less frequently, goals based on cerebro-metabolic or cerebral vascular self-regulation, are used both clinically and as clinical research subjects. However, overall support of the cardiovascular system, respiratory function, and nutritional or metabolic needs should not be overlooked and may also have a significant impact on outcome. Brain metabolic control through seizures or fever control may help improve outcomes. At present, optimal strategies for overall management are only partially in place. This lack of strong evidence may ultimately lead to institutional or individual variations in practice that may contribute to differences in outcomes.

Access to the paper:

Variation in general supportive and preventive intensive care management of traumatic brain injury: a survey in 66 neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Huijben JA, Volovici V, Cnossen MC, Haitsma IK, Stocchetti N, Maas AIR, Menon DK, Ercole A, Citerio G, Nelson D, Polinder S, Steyerberg EW, Lingsma HF, van der Jagt M; CENTER-TBI investigators and participants. Crit Care. 2018 Apr 13;22(1):90.    ]]>