Abstract
Background: Neurosurgical management of traumatic brain injury (TBI) is challenging, with only low-quality evidence. We aimed to explore differences in neurosurgical strategies for TBI across Europe. Methods: A survey was sent to 68 centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. The questionnaire contained 21 questions, including the decision when to operate (or not) on traumatic acute subdural hematoma (ASDH) and intracerebral hematoma (ICH), and when to perform a decompressive craniectomy (DC) in raised intracranial pressure (ICP). Results: The survey was completed by 68 centers (100%). On average, 10 neurosurgeons work in each trauma center. In all centers, a neurosurgeon was available within 30 min. Forty percent of responders reported a thickness or volume threshold for evacuation of an ASDH. Most responders (78%) decide on a primary DC in evacuating an ASDH during the operation, when swelling is present. For ICH, 3% would perform an evacuation directly to prevent secondary deterioration and 66% only in case of clinical deterioration. Most respondents (91%) reported to consider a DC for refractory high ICP. The reported cut-off ICP for DC in refractory high ICP, however, differed: 60% uses 25 mmHg, 18% 30 mmHg, and 17% 20 mmHg. Treatment strategies varied substantially between regions, specifically for the threshold for ASDH surgery and DC for refractory raised ICP. Also within center variation was present: 31% reported variation within the hospital for inserting an ICP monitor and 43% for evacuating mass lesions. Conclusion: Despite a homogeneous organization, considerable practice variation exists of neurosurgical strategies for TBI in Europe. These results provide an incentive for comparative effectiveness research to determine elements of effective neurosurgical care.
| Original language | English |
|---|---|
| Pages (from-to) | 435-449 |
| Number of pages | 15 |
| Journal | Acta Neurochirurgica |
| Volume | 161 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - 13 Mar 2019 |
| Externally published | Yes |
Fingerprint
Dive into the research topics of 'Variation in neurosurgical management of traumatic brain injury: a survey in 68 centers participating in the CENTER-TBI study'. Together they form a unique fingerprint.Cite this
- APA
- Author
- BIBTEX
- Harvard
- Standard
- RIS
- Vancouver
}
In: Acta Neurochirurgica, Vol. 161, No. 3, 13.03.2019, p. 435-449.
Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Variation in neurosurgical management of traumatic brain injury
T2 - a survey in 68 centers participating in the CENTER-TBI study
AU - van Essen, Thomas A.
AU - Den Boogert, Hugo F.
AU - Cnossen, Maryse C.
AU - de Ruiter, Godard C.W.
AU - Haitsma, Iain
AU - Polinder, Suzanne
AU - Steyerberg, Ewout W.
AU - Menon, David
AU - Maas, Andrew I.R.
AU - Lingsma, Hester F.
AU - Peul, Wilco C.
AU - Cecilia, Ackerlund
AU - Hadie, Adams
AU - Vanni, Agnoletti
AU - Judith, Allanson
AU - Krisztina, Amrein
AU - Norberto, Andaluz
AU - Nada, Andelic
AU - Lasse, Andreassen
AU - Azasevac, Antun
AU - Audny, Anke
AU - Anna, Antoni
AU - Hilko, Ardon
AU - Gérard, Audibert
AU - Kaspars, Auslands
AU - Philippe, Azouvi
AU - Luisa, Azzolini Maria
AU - Camelia, Baciu
AU - Rafael, Badenes
AU - Ronald, Bartels
AU - Pál, Barzó
AU - Ursula, Bauerfeind
AU - Romuald, Beauvais
AU - Ronny, Beer
AU - Javier, Belda Francisco
AU - Bo-Michael, Bellander
AU - Antonio, Belli
AU - Rémy, Bellier
AU - Habib, Benali
AU - Thierry, Benard
AU - Maurizio, Berardino
AU - Luigi, Beretta
AU - Christopher, Beynon
AU - Federico, Bilotta
AU - Harald, Binder
AU - Erta, Biqiri
AU - Morten, Blaabjerg
AU - Hugo, Boogert
AU - Pierre, Bouzat
AU - Peter, Bragge
AU - Alexandra, Brazinova
AU - Vibeke, Brinck
AU - Joanne, Brooker
AU - Camilla, Brorsson
AU - Andras, Buki
AU - Monika, Bullinger
AU - Emiliana, Calappi
AU - Rosa, Calvi Maria
AU - Peter, Cameron
AU - Guillermo, Carbayo Lozano
AU - Marco, Carbonara
AU - Elsa, Carise
AU - Carpenter, K.
AU - Castaño-León, Ana M.
AU - Francesco, Causin
AU - Giorgio, Chevallard
AU - Arturo, Chieregato
AU - Giuseppe, Citerio
AU - Maryse, Cnossen
AU - Mark, Coburn
AU - Jonathan, Coles
AU - Lizzie, Coles Kemp
AU - Johnny, Collett
AU - Cooper, Jamie D.
AU - Marta, Correia
AU - Amra, Covic
AU - Nicola, Curry
AU - Endre, Czeiter
AU - Marek, Czosnyka
AU - Claire, Dahyot Fizelier
AU - François, Damas
AU - Pierre, Damas
AU - Helen, Dawes
AU - Véronique, De Keyser
AU - Francesco, Della Corte
AU - Bart, Depreitere
AU - de Ruiter Godard, C. W.
AU - Dula, Dilvesi
AU - Shenghao, Ding
AU - Diederik, Dippel
AU - Abhishek, Dixit
AU - Emma, Donoghue
AU - Jens, Dreier
AU - Guy-Loup, Dulière
AU - George, Eapen
AU - Heiko, Engemann
AU - Ari, Ercole
AU - Patrick, Esser
AU - Erzsébet, Ezer
AU - Martin, Fabricius
AU - Feigin, Valery L.
AU - Junfeng, Feng
AU - Kelly, Foks
AU - Francesca, Fossi
AU - Gilles, Francony
AU - Ulderico, Freo
AU - Shirin, Frisvold
AU - Alex, Furmanov
AU - Pablo, Gagliardo
AU - Damien, Galanaud
AU - Dashiell, Gantner
AU - Guoyi, Gao
AU - Karin, Geleijns
AU - Pradeep, George
AU - Alexandre, Ghuysen
AU - Lelde, Giga
AU - Benoit, Giraud
AU - Ben, Glocker
AU - Jagos, Golubovic
AU - Gomez, Pedro A.
AU - Francesca, Grossi
AU - Gruen, Russell L.
AU - Deepak, Gupta
AU - Haagsma, Juanita A.
AU - Iain, Haitsma
AU - Hartings, Jed A.
AU - Raimund, Helbok
AU - Eirik, Helseth
AU - Daniel, Hertle
AU - Astrid, Hoedemaekers
AU - Stefan, Hoefer
AU - Lindsay, Horton
AU - Jilske, Huijben
AU - Hutchinson, Peter J.
AU - Kristine, Håberg Asta
AU - Bram, Jacobs
AU - Stefan, Jankowski
AU - Mike, Jarrett
AU - Bojan, Jelaca
AU - Ji-Yao, Jiang
AU - Kelly, Jones
AU - Konstantinos, Kamnitsas
AU - Mladen, Karan
AU - Ari, Katila
AU - Maija, Kaukonen
AU - Thomas, Kerforne
AU - Riku, Kivisaari
AU - Kolias, Angelos G.
AU - Bálint, Kolumbán
AU - Erwin, Kompanje
AU - Ksenija, Kolundzija
AU - Daniel, Kondziella
AU - Lars-Owe, Koskinen
AU - Noémi, Kovács
AU - Alfonso, Lagares
AU - Linda, Lanyon
AU - Steven, Laureys
AU - Fiona, Lecky
AU - Christian, Ledig
AU - Rolf, Lefering
AU - Valerie, Legrand
AU - Jin, Lei
AU - Leon, Levi
AU - Roger, Lightfoot
AU - Hester, Lingsma
AU - Dirk, Loeckx
AU - Angels, Lozano
AU - Maas, Andrew I.R.
AU - Stephen, Macdonald
AU - Marc, Maegele
AU - Marek, Majdan
AU - Sebastian, Major
AU - Alex, Manara
AU - Geoffrey, Manley
AU - Didier, Martin
AU - Francisco, Martin Leon
AU - Costanza, Martino
AU - Armando, Maruenda
AU - Hugues, Maréchal
AU - Alessandro, Masala
AU - Julia, Mattern
AU - Charles, McFadyen
AU - Catherine, McMahon
AU - Béla, Melegh
AU - David, Menon
AU - Tomas, Menovsky
AU - Cristina, Morganti Kossmann
AU - Davide, Mulazzi
AU - Visakh, Muraleedharan
AU - Lynnette, Murray
AU - Holger, Mühlan
AU - Nandesh, Nair
AU - Ancuta, Negru
AU - David, Nelson
AU - Virginia, Newcombe
AU - Daan, Nieboer
AU - Quentin, Noirhomme
AU - József, Nyirádi
AU - Mauro, Oddo
AU - Annemarie, Oldenbeuving
AU - Matej, Oresic
AU - Fabrizio, Ortolano
AU - Aarno, Palotie
AU - Parizel, Paul M.
AU - Adriana, Patruno
AU - Jean-François, Payen
AU - Natascha, Perera
AU - Vincent, Perlbarg
AU - Paolo, Persona
AU - Wilco, Peul
AU - Anna, Piippo Karjalainen
AU - Sébastien, Pili Floury
AU - Matti, Pirinen
AU - Horia, Ples
AU - Antonia, Poca Maria
AU - Suzanne, Polinder
AU - Inigo, Pomposo
AU - Jussi, Posti
AU - Louis, Puybasset
AU - Andreea, Radoi
AU - Arminas, Ragauskas
AU - Rahul, Raj
AU - Malinka, Rambadagalla
AU - Ruben, Real
AU - Veronika, Rehorčíková
AU - Jonathan, Rhodes
AU - Samuli, Ripatti
AU - Saulius, Rocka
AU - Cecilie, Roe
AU - Olav, Roise
AU - Gerwin, Roks
AU - Jonathan, Rosand
AU - Jeffrey, Rosenfeld
AU - Christina, Rosenlund
AU - Guy, Rosenthal
AU - Rolf, Rossaint
AU - Sandra, Rossi
AU - Daniel, Rueckert
AU - Martin, Rusnák
AU - Marco, Sacchi
AU - Barbara, Sahakian
AU - Juan, Sahuquillo
AU - Oliver, Sakowitz
AU - Francesca, Sala
AU - Renan, Sanchez Porras
AU - Janos, Sandor
AU - Edgar, Santos
AU - Luminita, Sasu
AU - Davide, Savo
AU - Nadine, Schäffer
AU - Inger, Schipper
AU - Barbara, Schlößer
AU - Silke, Schmidt
AU - Herbert, Schoechl
AU - Guus, Schoonman
AU - Frederik, Schouico
AU - Elisabeth, Schwendenwein
AU - Michael, Schöll
AU - Özcan, Sir
AU - Toril, Skandsen
AU - Lidwien, Smakman
AU - Dirk, Smeets
AU - Peter, Smielewski
AU - Abayomi, Sorinola
AU - Emmanuel, Stamatakis
AU - Simon, Stanworth
AU - Nicole, Steinbüchel
AU - Ana, Stevanovic
AU - Robert, Stevens
AU - William, Stewart
AU - Nino, Stocchetti
AU - Nina, Sundström
AU - Anneliese, Synnot
AU - Silvio, Taccone Fabio
AU - Riikka, Takala
AU - Viktória, Tamás
AU - Päivi, Tanskanen
AU - Steven, Taylor Mark
AU - Braden, Te Ao
AU - Olli, Tenovuo
AU - Ralph, Telgmann
AU - Guido, Teodorani
AU - Alice, Theadom
AU - Matt, Thomas
AU - Dick, Tibboel
AU - Christos, Tolias
AU - Luaba, Tshibanda Jean Flory
AU - Tony, Trapani
AU - Maria, Tudora Cristina
AU - Peter, Vajkoczy
AU - Shirley, Vallance
AU - Egils, Valeinis
AU - Gregory, Van der Steen
AU - Mathieu, van der Jagt
AU - Joukje, van der Naalt
AU - van Dijck, Jeroen T.J.M.
AU - van Essen, Thomas A.
AU - Van Hecke, Wim
AU - van Heugten, Caroline
AU - Van Praag, Dominique
AU - Thijs, Vande Vyvere
AU - Julia, Van Waesberghe
AU - Audrey, Vanhaudenhuyse
AU - Alessia, Vargiolu
AU - Emmanuel, Vega
AU - Kimberley, Velt
AU - Jan, Verheyden
AU - Vespa, Paul M.
AU - Anne, Vik
AU - Rimantas, Vilcinis
AU - Giacinta, Vizzino
AU - Carmen, Vl Eggeert Lankamp
AU - Victor, Volovici
AU - Daphne, Voormolen
AU - Peter, Vulekovic
AU - Zoltán, Vámos
AU - Derick, Wade
AU - Wang, Kevin K.W.
AU - Lei, Wang
AU - Lars, Wessels
AU - Eno, Wildschut
AU - Guy, Williams
AU - Lindsay, Wilson
AU - Winkler, Maren K.L.
AU - Stefan, Wolf
AU - Peter, Ylén
AU - Alexander, Younsi
AU - Menashe, Zaaroor
AU - Yang, Zhihui
AU - Agate, Ziverte
AU - Fabrizio, Zumbo
N1 - Publisher Copyright: © 2018, The Author(s).
PY - 2019/3/13
Y1 - 2019/3/13
N2 - Background: Neurosurgical management of traumatic brain injury (TBI) is challenging, with only low-quality evidence. We aimed to explore differences in neurosurgical strategies for TBI across Europe. Methods: A survey was sent to 68 centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. The questionnaire contained 21 questions, including the decision when to operate (or not) on traumatic acute subdural hematoma (ASDH) and intracerebral hematoma (ICH), and when to perform a decompressive craniectomy (DC) in raised intracranial pressure (ICP). Results: The survey was completed by 68 centers (100%). On average, 10 neurosurgeons work in each trauma center. In all centers, a neurosurgeon was available within 30 min. Forty percent of responders reported a thickness or volume threshold for evacuation of an ASDH. Most responders (78%) decide on a primary DC in evacuating an ASDH during the operation, when swelling is present. For ICH, 3% would perform an evacuation directly to prevent secondary deterioration and 66% only in case of clinical deterioration. Most respondents (91%) reported to consider a DC for refractory high ICP. The reported cut-off ICP for DC in refractory high ICP, however, differed: 60% uses 25 mmHg, 18% 30 mmHg, and 17% 20 mmHg. Treatment strategies varied substantially between regions, specifically for the threshold for ASDH surgery and DC for refractory raised ICP. Also within center variation was present: 31% reported variation within the hospital for inserting an ICP monitor and 43% for evacuating mass lesions. Conclusion: Despite a homogeneous organization, considerable practice variation exists of neurosurgical strategies for TBI in Europe. These results provide an incentive for comparative effectiveness research to determine elements of effective neurosurgical care.
AB - Background: Neurosurgical management of traumatic brain injury (TBI) is challenging, with only low-quality evidence. We aimed to explore differences in neurosurgical strategies for TBI across Europe. Methods: A survey was sent to 68 centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. The questionnaire contained 21 questions, including the decision when to operate (or not) on traumatic acute subdural hematoma (ASDH) and intracerebral hematoma (ICH), and when to perform a decompressive craniectomy (DC) in raised intracranial pressure (ICP). Results: The survey was completed by 68 centers (100%). On average, 10 neurosurgeons work in each trauma center. In all centers, a neurosurgeon was available within 30 min. Forty percent of responders reported a thickness or volume threshold for evacuation of an ASDH. Most responders (78%) decide on a primary DC in evacuating an ASDH during the operation, when swelling is present. For ICH, 3% would perform an evacuation directly to prevent secondary deterioration and 66% only in case of clinical deterioration. Most respondents (91%) reported to consider a DC for refractory high ICP. The reported cut-off ICP for DC in refractory high ICP, however, differed: 60% uses 25 mmHg, 18% 30 mmHg, and 17% 20 mmHg. Treatment strategies varied substantially between regions, specifically for the threshold for ASDH surgery and DC for refractory raised ICP. Also within center variation was present: 31% reported variation within the hospital for inserting an ICP monitor and 43% for evacuating mass lesions. Conclusion: Despite a homogeneous organization, considerable practice variation exists of neurosurgical strategies for TBI in Europe. These results provide an incentive for comparative effectiveness research to determine elements of effective neurosurgical care.
KW - Acute subdural hematoma
KW - Neurosurgery
KW - Practice variation
KW - Traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=85058948585&partnerID=8YFLogxK
U2 - 10.1007/s00701-018-3761-z
DO - 10.1007/s00701-018-3761-z
M3 - Article
SN - 0001-6268
VL - 161
SP - 435
EP - 449
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
IS - 3
ER -