Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury: A survey in 66 neurotrauma centers participating in the CENTER-TBI study

Maryse C. Cnossen, Jilske A. Huijben, Mathieu van der Jagt, Victor Volovici, Thomas van Essen, Suzanne Polinder, David Nelson, Ari Ercole, Nino Stocchetti, Giuseppe Citerio, Wilco C. Peul, Andrew I.R. Maas, David Menon, Ewout W. Steyerberg, Hester F. Lingsma, Hadie Adams, Masala Alessandro, Judith Allanson, Krisztina Amrein, Norberto AndaluzNada Andelic, Nanni Andrea, Lasse Andreassen, Audny Anke, Anna Antoni, Hilko Ardon, Gérard Audibert, Kaspars Auslands, Philippe Azouvi, Camelia Baciu, Andrew Bacon, Rafael Badenes, Trevor Baglin, Ronald Bartels, Pál Barzó, Ursula Bauerfeind, Ronny Beer, Francisco Javier Belda, Bo Michael Bellander, Antonio Belli, Rémy Bellier, Habib Benali, Thierry Benard, Maurizio Berardino, Luigi Beretta, Christopher Beynon, Federico Bilotta, Harald Binder, Erta Biqiri, Morten Blaabjerg, Stine Borgen Lund, Pierre Bouzat, Peter Bragge, Alexandra Brazinova, Felix Brehar, Camilla Brorsson, Andras Buki, Monika Bullinger, Veronika Bucková, Emiliana Calappi, Peter Cameron, Lozano Guillermo Carbayo, Elsa Carise, Keri Carpenter, Ana M. Castaño-León, Francesco Causin, Giorgio Chevallard, Arturo Chieregato, M. Cooper, Mark Coburn, Jonathan Coles, Jamie D. Cooper, Marta Correia, Amra Covic, Nicola Curry, Endre Czeiter, Marek Czosnyka, Claire Dahyot-Fizelier, François Damas, Pierre Damas, Helen Dawes, Véronique De Keyser, Francesco Della Corte, Bart Depreitere, Shenghao Ding, Diederik Dippel, Kemal Dizdarevic, Guy Loup Dulière, Adelaida Dzeko, George Eapen, Heiko Engemann, Patrick Esser, Erzsébet Ezer, Martin Fabricius, Valery L. Feigin, Junfeng Feng, Kelly Foks, Francesca Fossi, Gilles Francony, Janek Frantzén, Ulderico Freo, Shirin Frisvold, Alex Furmanov, Pablo Gagliardo, Damien Galanaud, Guoyi Gao, Karin Geleijns, Alexandre Ghuysen, Benoit Giraud, Ben Glocker, Pedro A. Gomez, Francesca Grossi, Russell L. Gruen, Deepak Gupta, Juanita A. Haagsma, Ermin Hadzic, Iain Haitsma, Jed A. Hartings, Raimund Helbok, Eirik Helseth, Daniel Hertle, Sean Hill, Astrid Hoedemaekers, Stefan Hoefer, Peter J. Hutchinson, Kristine Asta Håberg, Bram Jacobs, Ivan Janciak, Koen Janssens, Ji Yao Jiang, Kelly Jones, Jean Pierre Kalala, Konstantinos Kamnitsas, Mladen Karan, Jana Karau, Ari Katila, Maija Kaukonen, David Keeling, Thomas Kerforne, Naomi Ketharanathan, Johannes Kettunen, Riku Kivisaari, Angelos G. Kolias, Bálint Kolumbán, Erwin Kompanje, Daniel Kondziella, Lars Owe Koskinen, Noémi Kovács, Ferenc Kálovits, Alfonso Lagares, Linda Lanyon, Steven Laureys, Martin Lauritzen, Fiona Lecky, Christian Ledig, Rolf Lefering, Valerie Legrand, Jin Lei, Leon Levi, Roger Lightfoot, Dirk Loeckx, Angels Lozano, Roger Luddington, Chantal Luijten-Arts, Stephen MacDonald, Charles MacFayden, Marc Maegele, Marek Majdan, Sebastian Major, Alex Manara, Pauline Manhes, Geoffrey Manley, Didier Martin, Costanza Martino, Armando Maruenda, Hugues Maréchal, Dagmara Mastelova, Julia Mattern, Catherine McMahon, Béla Melegh, Tomas Menovsky, Cristina Morganti-Kossmann, Davide Mulazzi, Manuel Mutschler, Holger Mühlan, Ancuta Negru, Eddy Neugebauer, Virginia Newcombe, Quentin Noirhomme, József Nyirádi, Mauro Oddo, Annemarie Oldenbeuving, Matej Oresic, Fabrizio Ortolano, Aarno Palotie, Paul M. Parizel, Adriana Patruno, Jean-Francois Payen de la Garanderie, Natascha Perera, Vincent Perlbarg, Paolo Persona, Nicolas Pichon, Henning Piilgaard, Anna Piippo, Sébastien Pili Floury, Matti Pirinen, Horia Ples, Inigo Pomposo, Marek Psota, Pim Pullens, Louis Puybasset, Arminas Ragauskas, Rahul Raj, Malinka Rambadagalla, Veronika Rehorcíková, Jonathan Rhodes, Sylvia Richardson, Samuli Ripatti, Saulius Rocka, Nicolas Rodier, Cecilie Roe, Olav Roise, Gerwin Roks, Pauline Romegoux, Jonathan Rosand, Jeffrey Rosenfeld, Christina Rosenlund, Guy Rosenthal, Rolf Rossaint, Sandra Rossi, Tim Rostalski, Daniel Rueckert, Arcaute Felix de Ruiz, Martin Rusnák, Marco Sacchi, Barbara Sahakian, Juan Sahuquillo, Oliver Sakowitz, Francesca Sala, Paola Sanchez-Pena, Renan Sanchez-Porras, Janos Sandor, Edgar Santos, Nadine Sasse, Luminita Sasu, Davide Savo, Inger Schipper, Barbara Schlößer, Silke Schmidt, Annette Schneider, Herbert Schoechl, Guus Schoonman, Frederik Schou Rico, Elisabeth Schwendenwein, Michael Schöll, özcan Sir, Toril Skandsen, Lidwien Smakman, Dirk Smeets, Peter Smielewski, Abayomi Sorinola, Emmanuel Stamatakis, Simon Stanworth, Katrin Stegemann, Nicole Steinbüchel, Robert Stevens, William Stewart, Nina Sundström, Anneliese Synnot, József Szabó, Jeannette Söderberg, Fabio Silvio Taccone, Viktória Tamás, Päivi Tanskanen, Alexandru Tascu, Mark Steven Taylor, Ao Braden Te, Olli Tenovuo, Guido Teodorani, Alice Theadom, Matt Thomas, Dick Tibboel, Christos Tolias, Jean Flory Luaba Tshibanda, Cristina Maria Tudora, Peter Vajkoczy, Egils Valeinis, Wim Van Hecke, Dominique Van Praag, Van Roost Dirk, Eline Van Vlierberghe, Thijs vande Vyvere, Audrey Vanhaudenhuyse, Alessia Vargiolu, Emmanuel Vega, Jan Verheyden, Paul M. Vespa, Anne Vik, Rimantas Vilcinis, Giacinta Vizzino, Carmen Vleggeert-Lankamp, Peter Vulekovic, Zoltán Vámos, Derick Wade, Kevin K.W. Wang, Lei Wang, Eno Wildschut, Guy Williams, Lisette Willumsen, Adam Wilson, Lindsay Wilson, Maren K.L. Winkler, Peter Ylén, Alexander Younsi, Menashe Zaaroor, Zhiqun Zhang, Zelong Zheng, Fabrizio Zumbo, Stefanie de Lange, Godard C.W. de Ruiter, Hugo den Boogert, Jeroen van Dijck, Caroline van Heugten, Joukje van der Naalt

Research output: Contribution to journalArticle

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 languageEnglish (US)
Article number233
JournalCritical Care
Volume21
Issue number1
DOIs
StatePublished - 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

Fingerprint Dive into the research topics of 'Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury: A survey in 66 neurotrauma centers participating in the CENTER-TBI study'. Together they form a unique fingerprint.

  • Cite this

    Cnossen, M. C., Huijben, J. A., van der Jagt, M., Volovici, V., van Essen, T., Polinder, S., Nelson, D., Ercole, A., Stocchetti, N., Citerio, G., Peul, W. C., Maas, A. I. R., Menon, D., Steyerberg, E. W., Lingsma, H. F., Adams, H., Alessandro, M., Allanson, J., Amrein, K., ... van der Naalt, J. (2017). Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury: A survey in 66 neurotrauma centers participating in the CENTER-TBI study. Critical Care, 21(1), [233]. https://doi.org/10.1186/s13054-017-1816-9