Brain Trauma Foundation Guideline Compliance: Results of a Multidisciplinary, International Survey.

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Brain Trauma Foundation Guideline Compliance: Results of a Multidisciplinary, International Survey.

World Neurosurg. 2018 May 08;:

Authors: Hirschi R, Rommel C, Letsinger J, Nirula R, John Hawryluk GW

Abstract
BACKGROUND: The Brain Trauma Foundation (BTF) guidelines reflect evidence-based best practices in the management of traumatic brain injury (TBI) however compliance varies.
OBJECTIVE: To inform self-reported physician compliance and predictors of compliance related to BTF guidelines via an international survey.
METHODS: We conducted an international, multidisciplinary survey examining self-reported adherence to the BTF guidelines and multiple factors potentially affecting adherence. We also surveyed intracranial pressure (ICP) monitoring practices.
RESULTS: Of 154 physician respondents, 15.9% report their institutions "Always" follow the BTF Guidelines and 72.2% report that they follow them "Most of the time". Personal volume of TBI cases and years in practice were not significantly related to adherence. Reported adherence varied significantly in association with the respondent's institutional trauma level (p=0.0010): 17.3% of practitioners at level I, 13.0% of level II, and 0% of level III trauma centers reported "Always" following guidelines. Reported adherence to guidelines also varied significantly in association with provider specialty (p=0.015) and institutional volume of severe TBI cases (p=0.008). For ICP monitoring practices, 52% of respondents report using external ventricular drains (EVDs) while 21% use intraparenchymal monitors and 27% have no preference (p < 0.001). Of those not routinely employing EVDs, 36% claim to "Always" follow guidelines. Moreover, there was no apparent association between type of ICP monitoring used and reported guideline adherence.
CONCLUSIONS: Few reported their institutions "Always" follow BTF guidelines. General surgeons and high-volume level 1 trauma centers were more likely to comply with guidelines. Differences in survey responses based on provider and institutional characteristics may help target educational efforts.

PMID: 29751187 [PubMed - as supplied by publisher]

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