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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

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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.
Keywords
EUROPEAN-BRAIN, HEAD-INJURY, MANAGEMENT, CARE, MORTALITY, PRESSURE, MODERATE, IMPACT, Traumatic brain injury, Intracranial hypertension, ICP, ICU, Comparative, effectiveness research, Survey

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Chicago
Cnossen, Maryse C., Jilske A. Huijben, Mathieu van der Jagt, Victor Volovici, Thomas van Essen, Suzanne Polinder, David Nelson, et al. 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.
APA
Cnossen, M. C., Huijben, J. A., van der Jagt, M., Volovici, V., van Essen, T., Polinder, S., Nelson, D., et al. (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.
Vancouver
1.
Cnossen MC, Huijben JA, van der Jagt M, Volovici V, van Essen T, Polinder S, et al. 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. London: Biomed Central Ltd; 2017;21.
MLA
Cnossen, Maryse C. et al. “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 (2017): n. pag. Print.
@article{8606533,
  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.},
  articleno    = {233},
  author       = {Cnossen, Maryse C. and Huijben, Jilske A. and van der Jagt, Mathieu and Volovici, Victor and van Essen, Thomas and Polinder, Suzanne and Nelson, David and Ercole, Ari and Stocchetti, Nino and Citerio, Giuseppe and Peul, Wilco C. and Maas, Andrew I. R. and Menon, David and Steyerberg, Ewout W. and Lingsma, Hester F.},
  issn         = {1466-609X},
  journal      = {CRITICAL CARE},
  language     = {eng},
  pages        = {12},
  publisher    = {Biomed Central Ltd},
  title        = {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},
  url          = {http://dx.doi.org/10.1186/s13054-017-1816-9},
  volume       = {21},
  year         = {2017},
}

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