Abstract
Background: No definitive evidence exists on how intracranial hypertension should be treated in patients with traumatic brain injury (TBI). It is therefore likely that centers and practitioners individually balance potential benefits and risks of different intracranial pressure (ICP) management strategies, resulting in practice variation. The aim of this study was to examine variation in monitoring and treatment policies for intracranial hypertension in patients with TBI. Methods: A 29-item survey on ICP monitoring and treatment was developed on the basis of literature and expert opinion, and it was pilot-tested in 16 centers. The questionnaire was sent to 68 neurotrauma centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Results: The survey was completed by 66 centers (97% response rate). Centers were mainly academic hospitals (n=60, 91%) and designated level I trauma centers (n=44, 67%). The Brain Trauma Foundation guidelines were used in 49 (74%) centers. Approximately 90% of the participants (n=58) indicated placing an ICP monitor in patients with severe TBI and computed tomographic abnormalities. There was no consensus on other indications or on peri-insertion precautions. We found wide variation in the use of first- and second-tier treatments for elevated ICP. Approximately half of the centers were classified as using a relatively aggressive approach to ICP monitoring and treatment (n=32, 48%), whereas the others were considered more conservative (n=34, 52%). Conclusions: Substantial variation was found regarding monitoring and treatment policies in patients with TBI and intracranial hypertension. The results of this survey indicate a lack of consensus between European neurotrauma centers and provide an opportunity and necessity for comparative effectiveness research.
| Original language | English (US) |
|---|---|
| Article number | 233 |
| Journal | Critical Care |
| Volume | 21 |
| Issue number | 1 |
| DOIs | |
| State | Published - Sep 6 2017 |
Keywords
- Comparative effectiveness research
- ICP
- ICU
- Intracranial hypertension
- Survey
- Traumatic brain injury
ASJC Scopus subject areas
- Critical Care and Intensive Care Medicine
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In: Critical Care, Vol. 21, No. 1, 233, 06.09.2017.
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TY - JOUR
T1 - Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury
T2 - A survey in 66 neurotrauma centers participating in the CENTER-TBI study
AU - Cnossen, Maryse C.
AU - Huijben, Jilske A.
AU - van der Jagt, Mathieu
AU - Volovici, Victor
AU - van Essen, Thomas
AU - Polinder, Suzanne
AU - Nelson, David
AU - Ercole, Ari
AU - Stocchetti, Nino
AU - Citerio, Giuseppe
AU - Peul, Wilco C.
AU - Maas, Andrew I.R.
AU - Menon, David
AU - Steyerberg, Ewout W.
AU - Lingsma, Hester F.
AU - Adams, Hadie
AU - Alessandro, Masala
AU - Allanson, Judith
AU - Amrein, Krisztina
AU - Andaluz, Norberto
AU - Andelic, Nada
AU - Andrea, Nanni
AU - Andreassen, Lasse
AU - Anke, Audny
AU - Antoni, Anna
AU - Ardon, Hilko
AU - Audibert, Gérard
AU - Auslands, Kaspars
AU - Azouvi, Philippe
AU - Baciu, Camelia
AU - Bacon, Andrew
AU - Badenes, Rafael
AU - Baglin, Trevor
AU - Bartels, Ronald
AU - Barzó, Pál
AU - Bauerfeind, Ursula
AU - Beer, Ronny
AU - Belda, Francisco Javier
AU - Bellander, Bo Michael
AU - Belli, Antonio
AU - Bellier, Rémy
AU - Benali, Habib
AU - Benard, Thierry
AU - Berardino, Maurizio
AU - Beretta, Luigi
AU - Beynon, Christopher
AU - Bilotta, Federico
AU - Binder, Harald
AU - Biqiri, Erta
AU - Blaabjerg, Morten
AU - Lund, Stine Borgen
AU - Bouzat, Pierre
AU - Bragge, Peter
AU - Brazinova, Alexandra
AU - Brehar, Felix
AU - Brorsson, Camilla
AU - Buki, Andras
AU - Bullinger, Monika
AU - Bucková, Veronika
AU - Calappi, Emiliana
AU - Cameron, Peter
AU - Carbayo, Lozano Guillermo
AU - Carise, Elsa
AU - Carpenter, Keri
AU - Castaño-León, Ana M.
AU - Causin, Francesco
AU - Chevallard, Giorgio
AU - Chieregato, Arturo
AU - Cooper, M.
AU - Coburn, Mark
AU - Coles, Jonathan
AU - Cooper, Jamie D.
AU - Correia, Marta
AU - Covic, Amra
AU - Curry, Nicola
AU - Czeiter, Endre
AU - Czosnyka, Marek
AU - Dahyot-Fizelier, Claire
AU - Damas, François
AU - Damas, Pierre
AU - Dawes, Helen
AU - De Keyser, Véronique
AU - Corte, Francesco Della
AU - Depreitere, Bart
AU - Ding, Shenghao
AU - Dippel, Diederik
AU - Dizdarevic, Kemal
AU - Dulière, Guy Loup
AU - Dzeko, Adelaida
AU - Eapen, George
AU - Engemann, Heiko
AU - Esser, Patrick
AU - Ezer, Erzsébet
AU - Fabricius, Martin
AU - Feigin, Valery L.
AU - Feng, Junfeng
AU - Foks, Kelly
AU - Fossi, Francesca
AU - Francony, Gilles
AU - Frantzén, Janek
AU - Freo, Ulderico
AU - Frisvold, Shirin
AU - Furmanov, Alex
AU - Gagliardo, Pablo
AU - Galanaud, Damien
AU - Gao, Guoyi
AU - Geleijns, Karin
AU - Ghuysen, Alexandre
AU - Giraud, Benoit
AU - Glocker, Ben
AU - Gomez, Pedro A.
AU - Grossi, Francesca
AU - Gruen, Russell L.
AU - Gupta, Deepak
AU - Haagsma, Juanita A.
AU - Hadzic, Ermin
AU - Haitsma, Iain
AU - Hartings, Jed A.
AU - Helbok, Raimund
AU - Helseth, Eirik
AU - Hertle, Daniel
AU - Hill, Sean
AU - Hoedemaekers, Astrid
AU - Hoefer, Stefan
AU - Hutchinson, Peter J.
AU - Håberg, Kristine Asta
AU - Jacobs, Bram
AU - Janciak, Ivan
AU - Janssens, Koen
AU - Jiang, Ji Yao
AU - Jones, Kelly
AU - Kalala, Jean Pierre
AU - Kamnitsas, Konstantinos
AU - Karan, Mladen
AU - Karau, Jana
AU - Katila, Ari
AU - Kaukonen, Maija
AU - Keeling, David
AU - Kerforne, Thomas
AU - Ketharanathan, Naomi
AU - Kettunen, Johannes
AU - Kivisaari, Riku
AU - Kolias, Angelos G.
AU - Kolumbán, Bálint
AU - Kompanje, Erwin
AU - Kondziella, Daniel
AU - Koskinen, Lars Owe
AU - Kovács, Noémi
AU - Kálovits, Ferenc
AU - Lagares, Alfonso
AU - Lanyon, Linda
AU - Laureys, Steven
AU - Lauritzen, Martin
AU - Lecky, Fiona
AU - Ledig, Christian
AU - Lefering, Rolf
AU - Legrand, Valerie
AU - Lei, Jin
AU - Levi, Leon
AU - Lightfoot, Roger
AU - Loeckx, Dirk
AU - Lozano, Angels
AU - Luddington, Roger
AU - Luijten-Arts, Chantal
AU - MacDonald, Stephen
AU - MacFayden, Charles
AU - Maegele, Marc
AU - Majdan, Marek
AU - Major, Sebastian
AU - Manara, Alex
AU - Manhes, Pauline
AU - Manley, Geoffrey
AU - Martin, Didier
AU - Martino, Costanza
AU - Maruenda, Armando
AU - Maréchal, Hugues
AU - Mastelova, Dagmara
AU - Mattern, Julia
AU - McMahon, Catherine
AU - Melegh, Béla
AU - Menovsky, Tomas
AU - Morganti-Kossmann, Cristina
AU - Mulazzi, Davide
AU - Mutschler, Manuel
AU - Mühlan, Holger
AU - Negru, Ancuta
AU - Neugebauer, Eddy
AU - Newcombe, Virginia
AU - Noirhomme, Quentin
AU - Nyirádi, József
AU - Oddo, Mauro
AU - Oldenbeuving, Annemarie
AU - Oresic, Matej
AU - Ortolano, Fabrizio
AU - Palotie, Aarno
AU - Parizel, Paul M.
AU - Patruno, Adriana
AU - Payen, Jean François
AU - Perera, Natascha
AU - Perlbarg, Vincent
AU - Persona, Paolo
AU - Pichon, Nicolas
AU - Piilgaard, Henning
AU - Piippo, Anna
AU - Floury, Sébastien Pili
AU - Pirinen, Matti
AU - Ples, Horia
AU - Pomposo, Inigo
AU - Psota, Marek
AU - Pullens, Pim
AU - Puybasset, Louis
AU - Ragauskas, Arminas
AU - Raj, Rahul
AU - Rambadagalla, Malinka
AU - Rehorcíková, Veronika
AU - Rhodes, Jonathan
AU - Richardson, Sylvia
AU - Ripatti, Samuli
AU - Rocka, Saulius
AU - Rodier, Nicolas
AU - Roe, Cecilie
AU - Roise, Olav
AU - Roks, Gerwin
AU - Romegoux, Pauline
AU - Rosand, Jonathan
AU - Rosenfeld, Jeffrey
AU - Rosenlund, Christina
AU - Rosenthal, Guy
AU - Rossaint, Rolf
AU - Rossi, Sandra
AU - Rostalski, Tim
AU - Rueckert, Daniel
AU - de Ruiz, Arcaute Felix
AU - Rusnák, Martin
AU - Sacchi, Marco
AU - Sahakian, Barbara
AU - Sahuquillo, Juan
AU - Sakowitz, Oliver
AU - Sala, Francesca
AU - Sanchez-Pena, Paola
AU - Sanchez-Porras, Renan
AU - Sandor, Janos
AU - Santos, Edgar
AU - Sasse, Nadine
AU - Sasu, Luminita
AU - Savo, Davide
AU - Schipper, Inger
AU - Schlößer, Barbara
AU - Schmidt, Silke
AU - Schneider, Annette
AU - Schoechl, Herbert
AU - Schoonman, Guus
AU - Rico, Frederik Schou
AU - Schwendenwein, Elisabeth
AU - Schöll, Michael
AU - Sir, özcan
AU - Skandsen, Toril
AU - Smakman, Lidwien
AU - Smeets, Dirk
AU - Smielewski, Peter
AU - Sorinola, Abayomi
AU - Stamatakis, Emmanuel
AU - Stanworth, Simon
AU - Stegemann, Katrin
AU - Steinbüchel, Nicole
AU - Stevens, Robert
AU - Stewart, William
AU - Sundström, Nina
AU - Synnot, Anneliese
AU - Szabó, József
AU - Söderberg, Jeannette
AU - Taccone, Fabio Silvio
AU - Tamás, Viktória
AU - Tanskanen, Päivi
AU - Tascu, Alexandru
AU - Taylor, Mark Steven
AU - Te, Ao Braden
AU - Tenovuo, Olli
AU - Teodorani, Guido
AU - Theadom, Alice
AU - Thomas, Matt
AU - Tibboel, Dick
AU - Tolias, Christos
AU - Tshibanda, Jean Flory Luaba
AU - Tudora, Cristina Maria
AU - Vajkoczy, Peter
AU - Valeinis, Egils
AU - Hecke, Wim Van
AU - Praag, Dominique Van
AU - Dirk, Van Roost
AU - Vlierberghe, Eline Van
AU - Vyvere, Thijs vande
AU - Vanhaudenhuyse, Audrey
AU - Vargiolu, Alessia
AU - Vega, Emmanuel
AU - Verheyden, Jan
AU - Vespa, Paul M.
AU - Vik, Anne
AU - Vilcinis, Rimantas
AU - Vizzino, Giacinta
AU - Vleggeert-Lankamp, Carmen
AU - Vulekovic, Peter
AU - Vámos, Zoltán
AU - Wade, Derick
AU - Wang, Kevin K.W.
AU - Wang, Lei
AU - Wildschut, Eno
AU - Williams, Guy
AU - Willumsen, Lisette
AU - Wilson, Adam
AU - Wilson, Lindsay
AU - Winkler, Maren K.L.
AU - Ylén, Peter
AU - Younsi, Alexander
AU - Zaaroor, Menashe
AU - Zhang, Zhiqun
AU - Zheng, Zelong
AU - Zumbo, Fabrizio
AU - de Lange, Stefanie
AU - de Ruiter, Godard C.W.
AU - den Boogert, Hugo
AU - van Dijck, Jeroen
AU - van Heugten, Caroline
AU - van der Naalt, Joukje
N1 - Publisher Copyright: © 2017 The Author(s).
PY - 2017/9/6
Y1 - 2017/9/6
N2 - Background: No definitive evidence exists on how intracranial hypertension should be treated in patients with traumatic brain injury (TBI). It is therefore likely that centers and practitioners individually balance potential benefits and risks of different intracranial pressure (ICP) management strategies, resulting in practice variation. The aim of this study was to examine variation in monitoring and treatment policies for intracranial hypertension in patients with TBI. Methods: A 29-item survey on ICP monitoring and treatment was developed on the basis of literature and expert opinion, and it was pilot-tested in 16 centers. The questionnaire was sent to 68 neurotrauma centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Results: The survey was completed by 66 centers (97% response rate). Centers were mainly academic hospitals (n=60, 91%) and designated level I trauma centers (n=44, 67%). The Brain Trauma Foundation guidelines were used in 49 (74%) centers. Approximately 90% of the participants (n=58) indicated placing an ICP monitor in patients with severe TBI and computed tomographic abnormalities. There was no consensus on other indications or on peri-insertion precautions. We found wide variation in the use of first- and second-tier treatments for elevated ICP. Approximately half of the centers were classified as using a relatively aggressive approach to ICP monitoring and treatment (n=32, 48%), whereas the others were considered more conservative (n=34, 52%). Conclusions: Substantial variation was found regarding monitoring and treatment policies in patients with TBI and intracranial hypertension. The results of this survey indicate a lack of consensus between European neurotrauma centers and provide an opportunity and necessity for comparative effectiveness research.
AB - Background: No definitive evidence exists on how intracranial hypertension should be treated in patients with traumatic brain injury (TBI). It is therefore likely that centers and practitioners individually balance potential benefits and risks of different intracranial pressure (ICP) management strategies, resulting in practice variation. The aim of this study was to examine variation in monitoring and treatment policies for intracranial hypertension in patients with TBI. Methods: A 29-item survey on ICP monitoring and treatment was developed on the basis of literature and expert opinion, and it was pilot-tested in 16 centers. The questionnaire was sent to 68 neurotrauma centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Results: The survey was completed by 66 centers (97% response rate). Centers were mainly academic hospitals (n=60, 91%) and designated level I trauma centers (n=44, 67%). The Brain Trauma Foundation guidelines were used in 49 (74%) centers. Approximately 90% of the participants (n=58) indicated placing an ICP monitor in patients with severe TBI and computed tomographic abnormalities. There was no consensus on other indications or on peri-insertion precautions. We found wide variation in the use of first- and second-tier treatments for elevated ICP. Approximately half of the centers were classified as using a relatively aggressive approach to ICP monitoring and treatment (n=32, 48%), whereas the others were considered more conservative (n=34, 52%). Conclusions: Substantial variation was found regarding monitoring and treatment policies in patients with TBI and intracranial hypertension. The results of this survey indicate a lack of consensus between European neurotrauma centers and provide an opportunity and necessity for comparative effectiveness research.
KW - Comparative effectiveness research
KW - ICP
KW - ICU
KW - Intracranial hypertension
KW - Survey
KW - Traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=85028927488&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85028927488&partnerID=8YFLogxK
U2 - 10.1186/s13054-017-1816-9
DO - 10.1186/s13054-017-1816-9
M3 - Article
C2 - 28874206
AN - SCOPUS:85028927488
SN - 1364-8535
VL - 21
JO - Critical Care
JF - Critical Care
IS - 1
M1 - 233
ER -