Journal:Journal of Neurosurgery
Year, Volume, Issue, Page(s):14, 120, 3, 773-777
Study measured compliance with evidence-based management (EBM) guidelines for management of severe traumatic brain injury (TBI) and its impact on patient outcome. This was a secondary analysis of data collected from 2,056 patients with blunt TBI from 11 Level I trauma centers over a 2-year period. The authors measured compliance with 6 non-operative EBM processes of care: endotracheal intubation, resuscitation, correction of coagulopathy, intracranial pressure (ICP) monitoring, ICP-directed therapy, and discharge to rehabilitation. Compliance rates were calculated for each center using multivariate regression to adjust for patient demographics, physiology, injury severity, and TBI severity. The overall compliance rate was 73 percent, and there was wide variation among centers. Only 3 centers achieved a compliance rate exceeding 80 percent. Risk-adjusted compliance was worse than average at 2 centers, better than average at 1, and the remainder were average. Multivariate analysis showed that increased adoption of EBM was associated with a reduced mortality rate. Findings indicate that despite widespread dissemination of EBM guidelines, patients with severe TBI continue to receive inconsistent care. Barriers to adoption of EBM need to be identified and mitigated to improve patient outcomes.