Traumatic brain injury from external physical force can lead to an alteration to brain function. Center-TBI, a European consortium of experts that aims to improve the care of TBI patients, reports that 50 million new cases of TBI occur each year globally. Pediatric and elderly populations are at particular risk in developed countries, and automotive crashes, which are increasingly likely to be connected to cell phone use while driving, remain a significant cause of TBI as well.

The effects of TBI include physical, cognitive, emotional, and psychological impairment that can occur even with mild disease. While the direct cost to the health care system is high, the indirect damages to society are potentially more significant. These take the form of lost productivity, a compromised ability to work, and time that family or caretakers lose in their work while caring for someone suffering long-term accident-related complications.

Are European trauma care sites following established guidelines for care?

A major study that appeared in World Neurosurgery earlier this year investigated how facilities are caring for the vulnerable and growing TBI patient cohort. Adherence to established guidelines for TBI management reduce practice variation and provide a coherent foundation for research and communication.

Authors from institutions that include Erasmus University Medical Center, the University of Cambridge, the Karolinska Institutet, and Antwerp University Hospital-University of Antwerp investigated whether institutions were following care guidelines and if not, the reasons for non-adherence.

Design and methods

The authors coordinated a prospective, observational multi-center cohort study of 68 trauma centers located across 20 European countries. Questionnaires sought data on clinical management of severe TBI, including whether it integrated the use of standardized guidelines for care.

Results

A total of 65 centers responded, and of those, 75% reported the use of the Brain Trauma Foundation guidelines for treatment and related protocols. Only 17% of those institutions that responded used no guidelines and a small number used other guidelines. Among those centers that reported they used guidelines, 75% used written guidelines, and 7% reported they had no formal implementation plan.

The most frequently cited reasons for non-adherence to established guidelines were that each trauma patient has a unique set of circumstances and that extracranial injuries, such as those from an automobile collision, can be present concurrently. All reporting institutions agreed on these impediments, whether they used guidelines in TBI care or not.

Impact

The efforts the Center-TBI study highlights reveal substantial variation among European neurotrauma centers in their use and implementation of existing guidelines regarding TBI patient care. These findings underscore a need for further evidence to fortify existing guidelines and to modify barriers to implementation.

The populations that TBI effects are changing rapidly. The average age of patients who are admitted to care centers with more severe TBI has more than doubled since the 1980s, and incidences of TBI among children who are four years old or younger are on the rise as well. These patients need the data-driven results of large and well-designed studies in a timely manner.

QuesGen can help with study management and data collection and curation. Learn about assistance for the next significant step forward in findings for quality care.