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

被引：51

作者：

van Essen, Thomas A. ^{[1
,2
]}

den Boogert, Hugo F. ^{[3
]}

Cnossen, Maryse C. ^{[4
]}

de Ruiter, Godard C. W. ^{[2
]}

Haitsma, Iain ^{[5
]}

Polinder, Suzanne ^{[4
]}

Steyerberg, Ewout W. ^{[4
,6
]}

Menon, David ^{[7
]}

Maas, Andrew I. R. ^{[8
,9
]}

Lingsma, Hester F. ^{[4
]}

Peul, Wilco C. ^{[1
,2
]}

Cecilia, Ackerlund ^{[10
]}

Hadie, Adams ^{[11
,12
]}

Vanni, Agnoletti ^{[13
]}

Judith, Allanson ^{[12
,14
]}

Krisztina, Amrein ^{[15
]}

Norberto, Andaluz ^{[16
]}

Nada, Andelic ^{[17
,18
]}

Lasse, Andreassen ^{[19
]}

Azasevac, Antun ^{[20
]}

Audny, Anke ^{[21
]}

Anna, Antoni ^{[22
]}

Hilko, Ardon ^{[23
]}

Gerard, Audibert ^{[24
]}

Kaspars, Auslands ^{[25
]}

Philippe, Azouvi ^{[26
]}

Luisa, Azzolini Maria ^{[27
]}

Camelia, Baciu ^{[28
]}

Rafael, Badenes ^{[29
]}

Ronald, Bartels ^{[30
]}

Pal, Barzo ^{[31
]}

Ursula, Bauerfeind ^{[32
]}

Romuald, Beauvais ^{[33
]}

Ronny, Beer ^{[34
]}

Francisco Javier, Belda ^{[29
]}

Bo-Michael, Bellander ^{[35
]}

Antonio, Belli ^{[36
]}

Remy, Bellier ^{[37
]}

Habib, Benali ^{[38
]}

Thierry, Benard ^{[37
]}

Maurizio, Berardino ^{[39
]}

Luigi, Beretta ^{[27
]}

Christopher, Beynon ^{[40
]}

Federico, Bilotta ^{[29
]}

Harald, Binder ^{[22
]}

Erta, Biqiri ^{[28
]}

Morten, Blaabjerg ^{[41
]}

Hugo, den Boogert ^{[30
]}

Pierre, Bouzat ^{[42
]}

Peter, Bragge ^{[43
]}

机构：

[1] Leiden Univ, UNCH, Dept Neurosurg, Med Ctr, Leiden, Netherlands

[2] UNCH, Haaglanden Med Ctr, Dept Neurosurg, The Hague, Netherlands

[3] Radboud Univ Nijmegen, Med Ctr, Dept Neurosurg, Nijmegen, Netherlands

[4] Erasmus MC, Dept Publ Hlth, Ctr Med Decis Sci, Rotterdam, Netherlands

[5] Erasmus MC, Dept Neurosurg, Rotterdam, Netherlands

[6] Leiden Univ, Med Ctr, Dept Biomed Data Sci, Leiden, Netherlands

[7] Univ Cambridge, Div Anaesthesia, Addenbrookes Hosp, Cambridge, England

[8] Antwerp Univ Hosp, Dept Neurosurg, Edegem, Belgium

[9] Univ Antwerp, Edegem, Belgium

[10] Karolinska Inst, INCF Int Neuroinformat Coordinating Facil, Stockholm, Sweden

[11] Addenbrookes Hosp, Div Neurosurg, Dept Clin Neurosci, Cambridge, England

[12] Univ Cambridge, Cambridge, England

[13] Osped Gen Provinciale M Bufalini, Dept Anesthesia & Intens Care, Cesena, Italy

[14] Addenbrookes Hosp, Dept Clin Neurosci, Cambridge, England

[15] Univ Pecs, Janos Szentagothai Res Ctr, Pecs, Hungary

[16] Univ Cincinnati, Cincinnati, OH USA

[17] Oslo Univ Hosp, Div Surg & Clin Neurosci, Dept Phys Med & Rehabil, Oslo, Norway

[18] Univ Oslo, Oslo, Norway

[19] Univ Hosp Northern Norway, Dept Neurosurg, Tromso, Norway

[20] Univ Novi Sad, Fac Med, Dept Neurosurg, Clin Ctr Vojvodina, Novi Sad, Serbia

[21] Univ Hosp Northern Norway, Dept Phys Med & Rehabil, Tromso, Norway

[22] Med Univ Vienna, Trauma Surg, Vienna, Austria

[23] Elisabeth Tweesteden Ziekenhuis, Dept Neurosurg, Tilburg, Netherlands

[24] Univ Hosp Nancy, Dept Anesthesiol & Intens Care, Nancy, France

[25] Riga Eastern Clin Univ Hosp, Riga, Latvia

[26] Hop Raymond Poincare, AP HP, Paris, France

[27] S Raffaele Univ Hosp, Dept Anesthesiol & Intens Care, Milan, Italy

[28] Osped Niguarda Ca Granda, NeuroIntens Care, Milan, Italy

[29] Hosp Clin Univ Valencia, Dept Anesthesiol & Surg Trauma Intens Care, Valencia, Spain

[30] Radboud Univ Nijmegen, Dept Neurosurg, Med Ctr, Nijmegen, Netherlands

[31] Univ Szeged, Dept Neurosurg, Szeged, Hungary

[32] Witten Herdecke Univ, Inst Transfus Med ITM, Cologne, Germany

[33] ARTTIC, Int Projects Management, Munich, Germany

[34] Med Univ Innsbruck, Dept Neurol, Neurol Intens Care Unit, Innsbruck, Austria

[35] Karolinska Univ Hosp, Dept Neurosurg & Anesthesia & Intens Care Med, Stockholm, Sweden

[36] NIHR Surg Reconstruct & Microbiol Res Ctr, Birmingham, W Midlands, England

[37] CHU Poitiers, Intens Care Unit, Poitiers, France

[38] AP HP, Anesthesie Reanimat, Paris, France

[39] AOU Citta Salute & Sci Torino, Dept Anesthesia & ICU, Orthoped & Trauma Ctr, Turin, Italy

[40] Univ Hosp Heidelberg, Dept Neurosurg, Heidelberg, Germany

[41] Odense Univ Hosp, Dept Neurol, Odense, Denmark

[42] Univ Hosp Grenoble, Dept Anesthesiol & Intens Care, Grenoble, France

[43] Monash Univ, Monash Sustainabil Inst, BehaviourWorks Australia, Clayton, Vic, Australia

[44] Trnava Univ, Fac Hlth Sci & Social Work, Dept Publ Hlth, Trnava, Slovakia

[45] Quesgen Syst Inc, Burlingame, CA USA

[46] Monash Univ, Australian & New Zealand Intens Care Res Ctr, Dept Epidemiol & Prevent Med, Sch Publ Hlth & Prevent Med, Melbourne, Vic, Australia

[47] Umea Univ Hosp, Dept Neurosurg, Umea, Sweden

[48] Univ Pecs, Dept Neurosurg, Pecs, Hungary

[49] Univ Pecs, MTA PTE Clin Neurosci MR Res Grp, Hungarian Brain Res Program, Pecs, Hungary

[50] Univ Pecs, Janos Szentagothai Res Ctr, Hungarian Brain Res Program, Pecs, Hungary

来源：

ACTA NEUROCHIRURGICA | 2019年 / 161卷 / 03期

关键词：

Traumatic brain injury; Neurosurgery; Practice variation; Acute subdural hematoma; RANDOMIZED CONTROLLED-TRIALS; ACUTE SUBDURAL HEMATOMAS; SURGICAL-MANAGEMENT; GUIDELINES; MODERATE; OUTCOMES; SURGERY;

D O I：

10.1007/s00701-018-3761-z

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

BackgroundNeurosurgical 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.MethodsA 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).ResultsThe survey was completed by 68 centers (100%). On average, 10 neurosurgeons work in each trauma center. In all centers, a neurosurgeon was available within 30min. 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 25mmHg, 18% 30mmHg, and 17% 20mmHg. 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.ConclusionDespite 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.

引用

页码：435 / 449

页数：15

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