dc.contributor.author | Van Essen, Thomas | |
dc.contributor.author | den Boogert, HF | |
dc.contributor.author | Cnossen, MC | |
dc.contributor.author | De Ruiter, Godard CW | |
dc.contributor.author | Haitsma, Ian | |
dc.contributor.author | Polinder, S | |
dc.contributor.author | Steyerberg, Ewout W. | |
dc.contributor.author | Menon, David | |
dc.contributor.author | Maas, Andrew I. R. | |
dc.contributor.author | Lingsma, Hester F | |
dc.contributor.author | Peul, Wilco | |
dc.contributor.author | Andelic, Nada | |
dc.contributor.author | Helseth, Eirik | |
dc.contributor.author | Roise, O | |
dc.contributor.author | Røe, Cecilie | |
dc.contributor.author | Vik, Anne | |
dc.contributor.author | Skandsen, Toril | |
dc.contributor.author | Anke, Audny | |
dc.contributor.author | Frisvold, Shirin Kordasti | |
dc.contributor.author | Andreassen, Lasse | |
dc.contributor.author | Håberg, Asta | |
dc.date.accessioned | 2019-02-21T10:31:31Z | |
dc.date.available | 2019-02-21T10:31:31Z | |
dc.date.created | 2019-01-26T09:23:53Z | |
dc.date.issued | 2018 | |
dc.identifier.issn | 0001-6268 | |
dc.identifier.uri | http://hdl.handle.net/11250/2586708 | |
dc.description.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. | nb_NO |
dc.language.iso | eng | nb_NO |
dc.publisher | Springer | nb_NO |
dc.rights | Navngivelse 4.0 Internasjonal | * |
dc.rights.uri | http://creativecommons.org/licenses/by/4.0/deed.no | * |
dc.title | Variation in neurosurgical management of traumatic brain injury: a survey in 68 centers participating in the CENTER-TBI study. | nb_NO |
dc.type | Journal article | nb_NO |
dc.type | Peer reviewed | nb_NO |
dc.description.version | publishedVersion | nb_NO |
dc.source.journal | Acta Neurochirurgica | nb_NO |
dc.identifier.doi | 10.1007/s00701-018-3761-z | |
dc.identifier.cristin | 1665415 | |
dc.description.localcode | © The Author(s) 2018 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. | nb_NO |
cristin.unitcode | 194,65,30,0 | |
cristin.unitname | Institutt for nevromedisin og bevegelsesvitenskap | |
cristin.ispublished | true | |
cristin.fulltext | original | |
cristin.qualitycode | 1 | |