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1. Variation in neurosurgical management of traumatic brain injury: a survey in 68 centers participating in the CENTER-TBI study

Author

van Essen T. A., den Boogert H. F., Cnossen M. C., de Ruiter G. C. W., Haitsma I., Polinder S., Steyerberg E. W., Menon D., Maas A. I. R., Lingsma H. F., Peul W. C., Cecilia A., Hadie A., Vanni A., Judith A., Krisztina A., Norberto A., Nada A., Lasse A., Azasevac A., Audny A., Anna A., Hilko A., Gerard A., Kaspars A., Philippe A., Luisa A. M., Camelia B., Rafael B., Ronald B., Pal B., Ursula B., Romuald B., Ronny B., Javier B. F., Bo-Michael B., Antonio B., Remy B., Habib B., Thierry B., Maurizio B., Luigi B., Christopher B., Federico B., Harald B., Erta B., Morten B., den Hugo B., Pierre B., Peter B., Alexandra B., Vibeke B., Joanne B., Camilla B., Andras B., Monika B., Emiliana C., Rosa C. M., Peter C., Guillermo C. L., Marco C., Elsa C., Carpenter K., Castano-Leon Ana M., Francesco C., Giorgio C., Arturo C., Giuseppe C., Maryse C., Mark C., Jonathan C., Lizzie C. -K., Johnny C., Cooper Jamie D., Marta C., Amra C., Nicola C., Endre C., Marek C., Claire D. -F., Francois D., Pierre D., Helen D., Veronique D. K., Francesco D. C., Bart D., de Ruiter Godard C. W., Dula D., Shenghao D., Diederik D., Abhishek D., Emma D., Jens D., Guy-Loup D., George E., Heiko E., Ari E., Patrick E., Erzsebet E., Martin F., Feigin Valery L., Junfeng F., Kelly F., Francesca F., Gilles F., Ulderico F., Shirin F., Alex F., Pablo G., Damien G., Dashiell G., Guoyi G., Karin G., Pradeep G., Alexandre G., Lelde G., Benoit G., Ben G., Jagos G., Gomez Pedro A., Francesca G., Gruen Russell L., Deepak G., Haagsma Juanita A., Iain H., Hartings Jed A., Raimund H., Eirik H., Daniel H., Astrid H., Stefan H., Lindsay H., Jilske H., Hutchinson Peter J., Kristine H. A., Bram J., Stefan J., Mike J., Bojan J., Ji-yao J., Kelly J., Konstantinos K., Mladen K., Ari K., Maija K., Thomas K., Riku K., Kolias Angelos G., Balint K., Erwin K., Ksenija K., Daniel K., Lars-Owe K., Noemi K., Alfonso L., Linda L., Steven L., Fiona L., Christian L., Rolf L., Valerie L., Jin L., Leon L., Roger L., Hester L., Dirk L., Angels L., Maas Andrew I. R., Stephen M. D., Marc M., Marek M., Sebastian M., Alex M., Geoffrey M., Didier M., Francisco M. L., Costanza M., Armando M., Hugues M., Alessandro M., Julia M., Charles M. F., Catherine M. M., Bela M., David M., Tomas M., Cristina M. -K., Davide M., Visakh M., Lynnette M., Holger M., Nandesh N., Ancuta N., David N., Virginia N., Daan N., Quentin N., Jozsef N., Mauro O., Annemarie O., Matej O., Fabrizio O., Aarno P., Parizel Paul M., Adriana P., Jean-Francois P., Natascha P., Vincent P., Paolo P., Wilco P., Anna P. -K., Sebastien P. F., Matti P., Horia P., Antonia P. M., Suzanne P., Inigo P., Jussi P., Louis P., Andreea R., Arminas R., Rahul R., Malinka R., Ruben R., Veronika R., Jonathan R., Samuli R., Saulius R., Cecilie R., Olav R., Gerwin R., Jeffrey R., Christina R., Guy R., Rolf R., Sandra R., Daniel R., Martin R., Marco S., Barbara S., Juan S., Oliver S., Francesca S., Renan S. -P., Janos S., Edgar S., Luminita S., Davide S., Nadine S., Inger S., Barbara S. ss., Silke S., Herbert S., Guus S., Frederik S. R., Elisabeth S., Michael S., Ozcan S., Toril S., Lidwien S., Dirk S., Peter S., Abayomi S., Emmanuel S., Simon S., Nicole S., Ana S., Robert S., William S., Steyerberg Ewout W., Nino S., Nina S., Anneliese S., Silvio T. F., Riikka T., Viktoria T., Paivi T., Steven T. M., Braden T. A., Olli T., Ralph T., Guido T., Alice T., Matt T., Dick T., Christos T., Luaba T. J. -F., Tony T., Maria T. C., Peter V., Shirley V., Egils V., der Steen Gregory V., van der Mathieu J., van der Joukje N., van Dijck Jeroen T. J. M., van Essen Thomas A., Wim V. H., van Caroline H., Dominique V. P., Thijs V. V., Julia V. W., Audrey V., Alessia V., Emmanuel V., Kimberley V., Jan V., Vespa Paul M., Anne V., Rimantas V., Giacinta V., Carmen V. -L., Victor V., Daphne V., Zoltan V., Derick W., Wang Kevin K. W., Lei W., Lars W., Eno W., Guy W., Lindsay W., Winkler Maren K. L., Stefan W., Peter Y., Alexander Y., Menashe Z., Yang Z., Agate Z., Fabrizio Z., Van Essen, T, den Boogert, H, Cnossen, M, de Ruiter, G, Haitsma, I, Polinder, S, Steyerberg, E, Menon, D, Maas, A, Lingsma, E, Peul, W, Citerio, G, CENTER-TBI Investigators and Participants, Ragauskas, Arminas, Ročka, Saulius, Vilcinis, Rimantas, Commission of the European Communities, Public Health, Neurosurgery, Menon, David [0000-0002-3228-9692], Apollo - University of Cambridge Repository, Clinicum, Department of Diagnostics and Therapeutics, Anestesiologian yksikkö, University of Helsinki, Neurokirurgian yksikkö, Doctoral Programme in Clinical Research, Centre of Excellence in Complex Disease Genetics, Aarno Palotie / Principal Investigator, Institute for Molecular Medicine Finland, Helsinki Institute for Information Technology, Biostatistics Helsinki, Samuli Olli Ripatti / Principal Investigator, University Management, Doctoral Programme in Social Sciences, HUS Perioperative, Intensive Care and Pain Medicine, Complex Disease Genetics, Genomics of Neurological and Neuropsychiatric Disorders, Statistical and population genetics, Psychology 3, Section Neuropsychology, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, RS: FPN NPPP I, Rocka, Saulius, „Springer' grupė, van Essen, T. A., den Boogert, H. F., Cnossen, M. C., de Ruiter, G. C. W., Haitsma, I., Polinder, S., Steyerberg, E. W., Menon, D., Maas, A. I. R., Lingsma, H. F., Peul, W. C., Cecilia, A., Hadie, A., Vanni, A., Judith, A., Krisztina, A., Norberto, A., Nada, A., Lasse, A., Azasevac, A., Audny, A., Anna, A., Hilko, A., Gerard, A., Kaspars, A., Philippe, A., Luisa, A. M., Camelia, B., Rafael, B., Ronald, B., Pal, B., Ursula, B., Romuald, B., Ronny, B., Javier, B. F., Bo-Michael, B., Antonio, B., Remy, B., Habib, B., Thierry, B., Maurizio, B., Luigi, B., Christopher, B., Federico, B., Harald, B., Erta, B., Morten, B., den Hugo, B., Pierre, B., Peter, B., Alexandra, B., Vibeke, B., Joanne, B., Camilla, B., Andras, B., Monika, B., Emiliana, C., Rosa, C. M., Peter, C., Guillermo, C. L., Marco, C., Elsa, C., Carpenter, K., Castano-Leon Ana, M., Francesco, C., Giorgio, C., Arturo, C., Giuseppe, C., Maryse, C., Mark, C., Jonathan, C., Lizzie, C. -K., Johnny, C., Cooper Jamie, D., Marta, C., Amra, C., Nicola, C., Endre, C., Marek, C., Claire, D. -F., Francois, D., Pierre, D., Helen, D., Veronique, D. K., Francesco, D. C., Bart, D., de Ruiter Godard, C. W., Dula, D., Shenghao, D., Diederik, D., Abhishek, D., Emma, D., Jens, D., Guy-Loup, D., George, E., Heiko, E., Ari, E., Patrick, E., Erzsebet, E., Martin, F., Feigin Valery, L., Junfeng, F., Kelly, F., Francesca, F., Gilles, F., Ulderico, F., Shirin, F., Alex, F., Pablo, G., Damien, G., Dashiell, G., Guoyi, G., Karin, G., Pradeep, G., Alexandre, G., Lelde, G., Benoit, G., Ben, G., Jagos, G., Gomez Pedro, A., Francesca, G., Gruen Russell, L., Deepak, G., Haagsma Juanita, A., Iain, H., Hartings Jed, A., Raimund, H., Eirik, H., Daniel, H., Astrid, H., Stefan, H., Lindsay, H., Jilske, H., Hutchinson Peter, J., Kristine, H. A., Bram, J., Stefan, J., Mike, J., Bojan, J., Ji-yao, J., Kelly, J., Konstantinos, K., Mladen, K., Ari, K., Maija, K., Thomas, K., Riku, K., Kolias Angelos, G., Balint, K., Erwin, K., Ksenija, K., Daniel, K., Lars-Owe, K., Noemi, K., Alfonso, L., Linda, L., Steven, L., Fiona, L., Christian, L., Rolf, L., Valerie, L., Jin, L., Leon, L., Roger, L., Hester, L., Dirk, L., Angels, L., Maas Andrew, I. R., Stephen, M. D., Marc, M., Marek, M., Sebastian, M., Alex, M., Geoffrey, M., Didier, M., Francisco, M. L., Costanza, M., Armando, M., Hugues, M., Alessandro, M., Julia, M., Charles, M. F., Catherine, M. M., Bela, M., David, M., Tomas, M., Cristina, M. -K., Davide, M., Visakh, M., Lynnette, M., Holger, M., Nandesh, N., Ancuta, N., David, N., Virginia, N., Daan, N., Quentin, N., Jozsef, N., Mauro, O., Annemarie, O., Matej, O., Fabrizio, O., Aarno, P., Parizel Paul, M., Adriana, P., Jean-Francois, P., Natascha, P., Vincent, P., Camici, Paolo, Wilco, P., Anna, P. -K., Sebastien, P. F., Matti, P., Horia, P., Antonia, P. M., Suzanne, P., Inigo, P., Jussi, P., Louis, P., Andreea, R., Arminas, R., Rahul, R., Malinka, R., Ruben, R., Veronika, R., Jonathan, R., Samuli, R., Saulius, R., Cecilie, R., Olav, R., Gerwin, R., Jeffrey, R., Christina, R., Guy, R., Rolf, R., Sandra, R., Daniel, R., Martin, R., Marco, S., Barbara, S., Juan, S., Oliver, S., Francesca, S., Renan, S. -P., Janos, S., Edgar, S., Luminita, S., Davide, S., Nadine, S., Inger, S., Barbara, S. ss., Silke, S., Herbert, S., Guus, S., Frederik, S. R., Elisabeth, S., Michael, S., Ozcan, S., Toril, S., Lidwien, S., Dirk, S., Peter, S., Abayomi, S., Emmanuel, S., Simon, S., Nicole, S., Ana, S., Robert, S., William, S., Steyerberg Ewout, W., Nino, S., Nina, S., Anneliese, S., Silvio, T. F., Riikka, T., Viktoria, T., Paivi, T., Steven, T. M., Braden, T. A., Olli, T., Ralph, T., Guido, T., Alice, T., Matt, T., Dick, T., Christos, T., Luaba, T. J. -F., Tony, T., Maria, T. C., Peter, V., Shirley, V., Egils, V., der Steen Gregory, V., van der Mathieu, J., van der Joukje, N., van Dijck Jeroen, T. J. M., van Essen Thomas, A., Wim, V. H., van Caroline, H., Dominique, V. P., Thijs, V. V., Julia, V. W., Audrey, V., Alessia, V., Emmanuel, V., Kimberley, V., Jan, V., Vespa Paul, M., Anne, V., Rimantas, V., Giacinta, V., Carmen, V. -L., Victor, V., Daphne, V., Zoltan, V., Derick, W., Wang Kevin, K. W., Lei, W., Lars, W., Eno, W., Guy, W., Lindsay, W., Winkler Maren, K. L., Stefan, W., Peter, Y., Alexander, Y., Menashe, Z., Yang, Z., Agate, Z., and Fabrizio, Z.

Subjects
SURGERY, medicine.medical_treatment, CENTER-TBI Investigators and Participants, GUIDELINES, 3124 Neurology and psychiatry, 030218 nuclear medicine & medical imaging, law.invention, 0302 clinical medicine, Traumatic brain injury, Randomized controlled trial, Trauma Centers, law, Neurosurgeons/standards, Surveys and Questionnaires, Brain Injuries, Traumatic, Acute subdural hematoma, Neurosurgery, Practice variation, VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Neurosurgery: 786, Neuroradiology, OUTCOMES, medicine.diagnostic_test, Trauma center, Interventional radiology, 3. Good health, Europe, Monitoring, Physiologic/methods, SURGICAL-MANAGEMENT, Decompressive craniectomy, Life Sciences & Biomedicine, medicine.medical_specialty, Decompressive Craniectomy/methods, Decompressive Craniectomy, RANDOMIZED CONTROLLED-TRIALS, Comparative effectiveness research, Clinical Decision-Making, Clinical Neurology, Brain Injuries, Traumatic/surgery, 03 medical and health sciences, Original Article - Brain trauma, medicine, Humans, VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Nevrokirurgi: 786, Trauma Centers/statistics & numerical data, acute subdural hematoma, neurosurgery, practice variation, traumatic brain injury, Monitoring, Physiologic, Neurology & Neurosurgery, Science & Technology, ACUTE SUBDURAL HEMATOMAS, business.industry, 3112 Neurosciences, 1103 Clinical Sciences, medicine.disease, nervous system diseases, Neurosurgeons, Emergency medicine, MODERATE, Neurology (clinical), Human medicine, Neurosciences & Neurology, business, 1109 Neurosciences, 030217 neurology & neurosurgery
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. © The Author(s) 2018 This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Published
2019
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2. Variation in neurosurgical management of traumatic brain injury: a survey in 68 centers participating in the CENTER-TBI study

Author

van Essen, TA, den Boogert, HF, Cnossen, MC, de Ruiter, GCW, Haitsma, I, Polinder, S, Steyerberg, EW, Menon, D, Maas, AIR, Lingsma, HF, Peul, WC, Cecilia, A, Hadie, A, Vanni, A, Judith, A, Krisztina, A, Norberto, A, Nada, A, Lasse, A, Azasevac, A, Audny, A, Anna, A, Hilko, A, Gerard, A, Kaspars, A, Philippe, A, Luisa, AM, Camelia, B, Rafael, B, Ronald, B, Pal, B, Ursula, B, Romuald, B, Ronny, B, Francisco Javier, B, Bo-Michael, B, Antonio, B, Remy, B, Habib, B, Thierry, B, Maurizio, B, Luigi, B, Christopher, B, Federico, B, Harald, B, Erta, B, Morten, B, Hugo, DB, Pierre, B, Peter, B, Alexandra, B, Vibeke, B, Joanne, B, Camilla, B, Andras, B, Monika, B, Emiliana, C, Rosa, CM, Peter, C, Lozano Guillermo, C, Marco, C, Elsa, C, Carpenter, K, Ana M, C-L, Francesco, C, Giorgio, C, Arturo, C, Giuseppe, C, Maryse, C, Mark, C, Jonathan, C, Lizzie, C-K, Johnny, C, Jamie, CD, Marta, C, Amra, C, Nicola, C, Endre, C, Marek, C, Claire, D-F, Francois, D, Pierre, D, Helen, D, Veronique, DK, Francesco, DC, Bart, D, Godard, DRCW, Dula, D, Ding, S, Diederik, D, Abhishek, D, Emma, D, Jens, D, Guy-Loup, D, George, E, Heiko, E, Ari, E, Patrick, E, Erzsebet, E, Martin, F, Valery, FL, Feng, J, Kelly, F, Francesca, F, Gilles, F, Ulderico, F, Shirin, F, Alex, F, Pablo, G, Damien, G, Dashiell, G, Gao, G, Karin, G, Pradeep, G, Alexandre, G, Lelde, G, Benoit, G, Ben, G, Jagos, G, Pedro, GA, Francesca, G, Russell, GL, Deepak, G, Juanita, HA, Iain, H, Jed, HA, Raimund, H, Eirik, H, Daniel, H, Astrid, H, Stefan, H, Lindsay, H, Jilske, H, Peter, HJ, Kristine, HA, Bram, J, Stefan, J, Mike, J, Bojan, J, Jiang, J-Y, Kelly, J, Konstantinos, K, Mladen, K, Ari, K, Maija, K, Thomas, K, Riku, K, Angelos, KG, Balint, K, Erwin, K, Ksenija, K, Daniel, K, Lars-Owe, K, Noemi, K, Alfonso, L, Linda, L, Steven, L, Fiona, L, Christian, L, Rolf, L, Valerie, L, Jin, L, Leon, L, Roger, L, Hester, L, Dirk, L, Angels, L, Andrew, MIR, Stephen, M, Marc, M, Marek, M, Sebastian, M, Alex, M, Geoffrey, M, Didier, M, Francisco, ML, Costanza, M, Armando, M, Hugues, M, Alessandro, M, Julia, M, Charles, M, Catherine, M, Bela, M, David, M, Tomas, M, Cristina, M-K, Davide, M, Visakh, M, Lynnette, M, Holger, M, Nandesh, N, Ancuta, N, David, N, Virginia, N, Daan, N, Quentin, N, Jozsef, N, Mauro, O, Annemarie, O, Matej, O, Fabrizio, O, Aarno, P, Paul, PM, Adriana, P, Jean-Francois, P, Natascha, P, Vincent, P, Paolo, P, PeulWilco, Anna, P-K, Sebastien, PF, Matti, P, Horia, P, Maria Antonia, P, Suzanne, P, Inigo, P, Jussi, P, Louis, P, Andreea, R, Arminas, R, Rahul, R, Malinka, R, Ruben, R, Veronika, R, Jonathan, R, Samuli, R, Saulius, R, Cecilie, R, Olav, R, Gerwin, R, Jeffrey, R, Christina, R, Guy, R, Rolf, R, Sandra, R, Daniel, R, Martin, R, Marco, S, Barbara, S, Juan, S, Oliver, S, Francesca, S, Renan, S-P, Janos, S, Edgar, S, Luminita, S, Davide, S, Nadine, S, Inger, S, Silke, S, Herbert, S, Guus, S, Frederik, SR, Elisabeth, S, Michael, S, Ozcan, S, Toril, S, Lidwien, S, Dirk, S, Peter, S, Abayomi, S, Emmanuel, S, Simon, S, Nicole, S, Ana, S, Robert, S, William, S, Ewout, SW, Nino, S, Nina, S, Anneliese, S, Fabio Silvio, T, Riikka, T, Viktoria, T, Paivi, T, Steven, TM, Braden, TA, Olli, T, Ralph, T, Guido, T, Alice, T, Matt, T, Dick, T, Christos, T, Luaba, TJ-F, Tony, T, Maria, TC, Peter, V, Shirley, V, Egils, V, Gregory, VDS, Mathieu, VDJ, Joukje, VDN, Jeroen, VDTJM, Thomas, VEA, Wim, VH, Caroline, VH, Dominique, VP, Thijs, VV, Julia, VW, Audrey, V, Alessia, V, Emmanuel, V, Kimberley, V, Jan, V, Paul, VM, Anne, V, Rimantas, V, Giacinta, V, Carmen, V-L, Victor, V, Daphne, V, Zoltan, V, Derick, W, Kevin, WKW, Lei, W, Lars, W, Eno, W, Guy, W, Lindsay, W, Maren, WKL, Stefan, W, Peter, Y, Alexander, Y, Menashe, Z, Yang, Z, Agate, Z, Fabrizio, Z, van Essen, TA, den Boogert, HF, Cnossen, MC, de Ruiter, GCW, Haitsma, I, Polinder, S, Steyerberg, EW, Menon, D, Maas, AIR, Lingsma, HF, Peul, WC, Cecilia, A, Hadie, A, Vanni, A, Judith, A, Krisztina, A, Norberto, A, Nada, A, Lasse, A, Azasevac, A, Audny, A, Anna, A, Hilko, A, Gerard, A, Kaspars, A, Philippe, A, Luisa, AM, Camelia, B, Rafael, B, Ronald, B, Pal, B, Ursula, B, Romuald, B, Ronny, B, Francisco Javier, B, Bo-Michael, B, Antonio, B, Remy, B, Habib, B, Thierry, B, Maurizio, B, Luigi, B, Christopher, B, Federico, B, Harald, B, Erta, B, Morten, B, Hugo, DB, Pierre, B, Peter, B, Alexandra, B, Vibeke, B, Joanne, B, Camilla, B, Andras, B, Monika, B, Emiliana, C, Rosa, CM, Peter, C, Lozano Guillermo, C, Marco, C, Elsa, C, Carpenter, K, Ana M, C-L, Francesco, C, Giorgio, C, Arturo, C, Giuseppe, C, Maryse, C, Mark, C, Jonathan, C, Lizzie, C-K, Johnny, C, Jamie, CD, Marta, C, Amra, C, Nicola, C, Endre, C, Marek, C, Claire, D-F, Francois, D, Pierre, D, Helen, D, Veronique, DK, Francesco, DC, Bart, D, Godard, DRCW, Dula, D, Ding, S, Diederik, D, Abhishek, D, Emma, D, Jens, D, Guy-Loup, D, George, E, Heiko, E, Ari, E, Patrick, E, Erzsebet, E, Martin, F, Valery, FL, Feng, J, Kelly, F, Francesca, F, Gilles, F, Ulderico, F, Shirin, F, Alex, F, Pablo, G, Damien, G, Dashiell, G, Gao, G, Karin, G, Pradeep, G, Alexandre, G, Lelde, G, Benoit, G, Ben, G, Jagos, G, Pedro, GA, Francesca, G, Russell, GL, Deepak, G, Juanita, HA, Iain, H, Jed, HA, Raimund, H, Eirik, H, Daniel, H, Astrid, H, Stefan, H, Lindsay, H, Jilske, H, Peter, HJ, Kristine, HA, Bram, J, Stefan, J, Mike, J, Bojan, J, Jiang, J-Y, Kelly, J, Konstantinos, K, Mladen, K, Ari, K, Maija, K, Thomas, K, Riku, K, Angelos, KG, Balint, K, Erwin, K, Ksenija, K, Daniel, K, Lars-Owe, K, Noemi, K, Alfonso, L, Linda, L, Steven, L, Fiona, L, Christian, L, Rolf, L, Valerie, L, Jin, L, Leon, L, Roger, L, Hester, L, Dirk, L, Angels, L, Andrew, MIR, Stephen, M, Marc, M, Marek, M, Sebastian, M, Alex, M, Geoffrey, M, Didier, M, Francisco, ML, Costanza, M, Armando, M, Hugues, M, Alessandro, M, Julia, M, Charles, M, Catherine, M, Bela, M, David, M, Tomas, M, Cristina, M-K, Davide, M, Visakh, M, Lynnette, M, Holger, M, Nandesh, N, Ancuta, N, David, N, Virginia, N, Daan, N, Quentin, N, Jozsef, N, Mauro, O, Annemarie, O, Matej, O, Fabrizio, O, Aarno, P, Paul, PM, Adriana, P, Jean-Francois, P, Natascha, P, Vincent, P, Paolo, P, PeulWilco, Anna, P-K, Sebastien, PF, Matti, P, Horia, P, Maria Antonia, P, Suzanne, P, Inigo, P, Jussi, P, Louis, P, Andreea, R, Arminas, R, Rahul, R, Malinka, R, Ruben, R, Veronika, R, Jonathan, R, Samuli, R, Saulius, R, Cecilie, R, Olav, R, Gerwin, R, Jeffrey, R, Christina, R, Guy, R, Rolf, R, Sandra, R, Daniel, R, Martin, R, Marco, S, Barbara, S, Juan, S, Oliver, S, Francesca, S, Renan, S-P, Janos, S, Edgar, S, Luminita, S, Davide, S, Nadine, S, Inger, S, Silke, S, Herbert, S, Guus, S, Frederik, SR, Elisabeth, S, Michael, S, Ozcan, S, Toril, S, Lidwien, S, Dirk, S, Peter, S, Abayomi, S, Emmanuel, S, Simon, S, Nicole, S, Ana, S, Robert, S, William, S, Ewout, SW, Nino, S, Nina, S, Anneliese, S, Fabio Silvio, T, Riikka, T, Viktoria, T, Paivi, T, Steven, TM, Braden, TA, Olli, T, Ralph, T, Guido, T, Alice, T, Matt, T, Dick, T, Christos, T, Luaba, TJ-F, Tony, T, Maria, TC, Peter, V, Shirley, V, Egils, V, Gregory, VDS, Mathieu, VDJ, Joukje, VDN, Jeroen, VDTJM, Thomas, VEA, Wim, VH, Caroline, VH, Dominique, VP, Thijs, VV, Julia, VW, Audrey, V, Alessia, V, Emmanuel, V, Kimberley, V, Jan, V, Paul, VM, Anne, V, Rimantas, V, Giacinta, V, Carmen, V-L, Victor, V, Daphne, V, Zoltan, V, Derick, W, Kevin, WKW, Lei, W, Lars, W, Eno, W, Guy, W, Lindsay, W, Maren, WKL, Stefan, W, Peter, Y, Alexander, Y, Menashe, Z, Yang, Z, Agate, Z, and Fabrizio, Z

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.

Published
2019

3. Variation in neurosurgical management of traumatic brain injury

Author

van Essen, T.A. (Thomas A.), den Boogert, H.F. (Hugo F.), Cnossen, M.C. (Maryse), De Ruiter, G.C.W. (Godard C.W.), Haitsma, I. (Iain), Polinder, S. (Suzanne), Steyerberg, E.W. (Ewout), Menon, D.K. (David ), Maas, A.I.R. (Andrew), Lingsma, H.F. (Hester), Peul, W.C. (Wilco), Cecilia, A. (Ackerlund), Hadie, A. (Adams), Vanni, A. (Agnoletti), Judith, A. (Allanson), Krisztina, A. (Amrein), Norberto, A. (Andaluz), Nada, A. (Andelic), Lasse, A. (Andreassen), Azasevac, A. (Antun), Audny, A. (Anke), Anna, A. (Antoni), Hilko, A. (Ardon), Gérard, A. (Audibert), Kaspars, A. (Auslands), Philippe, A. (Azouvi), Luisa, A.M. (Azzolini Maria), Camelia, B. (Baciu), Rafael, B. (Badenes), Ronald, B. (Bartels), Pál, B. (Barzó), Ursula, B. (Bauerfeind), Romuald, B. (Beauvais), Ronny, B. (Beer), Javier, B.F. (Belda Francisco), Bo-Michael, B. (Bellander), Antonio, B. (Belli), Rémy, B. (Bellier), Habib, B. (Benali), Thierry, B. (Benard), Maurizio, B. (Berardino), Luigi, B. (Beretta), Christopher, B. (Beynon), Federico, B. (Bilotta), Harald, B. (Binder), Erta, B. (Biqiri), Morten, B. (Blaabjerg), den Hugo, B. (Boogert), Pierre, B. (Bouzat), Peter, B. (Bragge), Alexandra, B. (Brazinova), Vibeke, B. (Brinck), Joanne, B. (Brooker), Camilla, B. (Brorsson), Andras, B. (Buki), Monika, B. (Bullinger), Emiliana, C. (Calappi), Rosa, C.M. (Calvi Maria), Peter, C. (Cameron), Guillermo, C.L. (Carbayo Lozano), Marco, C. (Carbonara), Elsa, C. (Carise), Carpenter, K.L.H. (Keri L.H.), Castaño-León Ana, M. (M.), Francesco, C. (Causin), Giorgio, C. (Chevallard), Arturo, C. (Chieregato), Giuseppe, C. (Citerio), Maryse, C. (Cnossen), Mark, C. (Coburn), Jonathan, C. (Coles), Lizzie, C.-K. (Coles-Kemp), Johnny, C. (Collett), Cooper Jamie, D. (D.), Marta, C. (Correia), Amra, C. (Covic), Nicola, C. (Curry), Endre, C. (Czeiter), Marek, C. (Czosnyka), Claire, D.-F. (Dahyot-Fizelier), François, D. (Damas), Pierre, D. (Damas), Helen, D. (Dawes), Véronique, D.K. (De Keyser), Francesco, D.C. (Della Corte), Bart, D. (Depreitere), de Ruiter Godard, C.W. (C. W.), Dula, D. (Dilvesi), Shenghao, D. (Ding), Diederik, D. (Dippel), Abhishek, D. (Dixit), Emma, D. (Donoghue), Jens, D. (Dreier), Guy-Loup, D. (Dulière), George, E. (Eapen), Heiko, E. (Engemann), Ari, E. (Ercole), Patrick, E. (Esser), Erzsébet, E. (Ezer), Martin, F. (Fabricius), Feigin Valery, L. (L.), Junfeng, F. (Feng), Kelly, F. (Foks), Francesca, F. (Fossi), Gilles, F. (Francony), Ulderico, F. (Freo), Shirin, F. (Frisvold), Alex, F. (Furmanov), Pablo, G. (Gagliardo), Damien, G. (Galanaud), Dashiell, G. (Gantner), Guoyi, G. (Gao), Karin, G. (Geleijns), Pradeep, G. (George), Alexandre, G. (Ghuysen), Lelde, G. (Giga), Benoit, G. (Giraud), Ben, G. (Glocker), Jagos, G. (Golubovic), Gomez Pedro, A. (A.), Francesca, G. (Grossi), Gruen Russell, L. (L.), Deepak, G. (Gupta), Haagsma Juanita, A. (A.), Iain, H. (Haitsma), Hartings Jed, A. (A.), Raimund, H. (Helbok), Eirik, H. (Helseth), Daniel, H. (Hertle), Astrid, H. (Hoedemaekers), Stefan, H. (Hoefer), Lindsay, H. (Horton), Jilske, H. (Huijben), Hutchinson Peter, J. (J.), Kristine, H.A. (Håberg Asta), Bram, J. (Jacobs), Stefan, J. (Jankowski), Mike, J. (Jarrett), Bojan, J. (Jelaca), Ji-yao, J. (Jiang), Kelly, J. (Jones), Konstantinos, K. (Kamnitsas), Mladen, K. (Karan), Ari, K. (Katila), Maija, K. (Kaukonen), Thomas, K. (Kerforne), Riku, K. (Kivisaari), Kolias Angelos, G. (G.), Bálint, K. (Kolumbán), Erwin, K. (Kompanje), Ksenija, K. (Kolundzija), Daniel, K. (Kondziella), Lars-Owe, K. (Koskinen), Noémi, K. (Kovács), Alfonso, L. (Lagares), Linda, L. (Lanyon), Steven, L. (Laureys), Fiona, L. (Lecky), Christian, L. (Ledig), Rolf, L. (Lefering), Valerie, L. (Legrand), Jin, L. (Lei), Leon, L. (Levi), Roger, L. (Lightfoot), Hester, L. (Lingsma), Dirk, L. (Loeckx), Angels, L. (Lozano), Maas Andrew, I.R. (I. R.), Stephen, M.D. (MacDonald), Marc, M. (Maegele), Marek, M. (Majdan), Sebastian, M. (Major), Alex, M. (Manara), Geoffrey, M. (Manley), Didier, M. (Martin), Francisco, M.L. (Martin Leon), Costanza, M. (Martino), Armando, M. (Maruenda), Hugues, M. (Maréchal), Alessandro, M. (Masala), Julia, M. (Mattern), Charles, M.F. (McFadyen), Catherine, M.M. (McMahon), Béla, M. (Melegh), David, M. (Menon), Tomas, M. (Menovsky), Cristina, M.-K. (Morganti-Kossmann), Davide, M. (Mulazzi), Visakh, M. (Muraleedharan), Lynnette, M. (Murray), Holger, M. (Mühlan), Nandesh, N. (Nair), Ancuta, N. (Negru), David, N. (Nelson), Virginia, N. (Newcombe), Daan, N. (Nieboer), Quentin, N. (Noirhomme), József, N. (Nyirádi), Mauro, O. (Oddo), Annemarie, O. (Oldenbeuving), Matej, O. (Oresic), Fabrizio, O. (Ortolano), Aarno, P. (Palotie), Parizel Paul, M. (M.), Adriana, P. (Patruno), Jean-François, P. (Payen), Natascha, P. (Perera), Vincent, P. (Perlbarg), Paolo, P. (Persona), Wilco, P. (Peul), Anna, P.-K. (Piippo-Karjalainen), Sébastien, P.F. (Pili Floury), Matti, P. (Pirinen), Horia, P. (Ples), Antonia, P.M. (Poca Maria), Suzanne, P. (Polinder), Inigo, P. (Pomposo), Jussi, P. (Posti), Louis, P. (Puybasset), Andreea, R. (Radoi), Arminas, R. (Ragauskas), Rahul, R. (Raj), Malinka, R. (Rambadagalla), Ruben, R. (Real), Veronika, R. (Rehorčíková), Jonathan, R. (Rhodes), Samuli, R. (Ripatti), Saulius, R. (Rocka), Cecilie, R. (Roe), Olav, R. (Roise), Gerwin, R. (Roks), Jonathan, R. (Rosand), Jeffrey, R. (Rosenfeld), Christina, R. (Rosenlund), Guy, R. (Rosenthal), Rolf, R. (Rossaint), Sandra, R. (Rossi), Daniel, R. (Rueckert), Martin, R. (Rusnák), Marco, S. (Sacchi), Barbara, S. (Sahakian), Juan, S. (Sahuquillo), Oliver, S. (Sakowitz), Francesca, S. (Sala), Renan, S.-P. (Sanchez-Porras), Janos, S. (Sandor), Edgar, S. (Santos), Luminita, S. (Sasu), Davide, S. (Savo), Nadine, S. (Schäffer), Inger, S. (Schipper), Barbara, S.ß. (Schlößer), Silke, S. (Schmidt), Herbert, S. (Schoechl), Guus, S. (Schoonman), Frederik, S.R. (Schou Rico), Elisabeth, S. (Schwendenwein), Michael, S. (Schöll), Özcan, S. (Sir), Toril, S. (Skandsen), Lidwien, S. (Smakman), Dirk, S. (Smeets), Peter, S. (Smielewski), Abayomi, S. (Sorinola), Emmanuel, S. (Stamatakis), Simon, S. (Stanworth), Nicole, S. (Steinbüchel), Ana, S. (Stevanovic), Robert, S. (Stevens), William, S. (Stewart), Steyerberg Ewout, W. (W.), Nino, S. (Stocchetti), Nina, S. (Sundström), Anneliese, S. (Synnot), Silvio, T.F. (Taccone Fabio), Riikka, T. (Takala), Viktória, T. (Tamás), Päivi, T. (Tanskanen), Steven, T.M. (Taylor Mark), Braden, T.A. (Te Ao), Olli, T. (Tenovuo), Ralph, T. (Telgmann), Guido, T. (Teodorani), Alice, T. (Theadom), Matt, T. (Thomas), Dick, T. (Tibboel), Christos, T. (Tolias), Luaba, T.J.-F. (Tshibanda Jean-Flory), Tony, T. (Trapani), Maria, T.C. (Tudora Cristina), Peter, V. (Vajkoczy), Shirley, V. (Vallance), Egils, V. (Valeinis), der Steen Gregory, V. (Van), van der Mathieu, J. (Jagt), van der Joukje, N. (Naalt), van Dijck Jeroen, T.J.M. (T. J.M.), van Essen Thomas, A. (A.), Wim, V.H. (Van Hecke), van Caroline, H. (Heugten), Dominique, V.P. (Van Praag), Thijs, V.V. (Vande Vyvere), Julia, V.W. (Van Waesberghe), Audrey, V. (Vanhaudenhuyse), Alessia, V. (Vargiolu), Emmanuel, V. (Vega), Kimberley, V. (Velt), Jan, V. (Verheyden), Vespa Paul, M. (M.), Anne, V. (Vik), Rimantas, V. (Vilcinis), Giacinta, V. (Vizzino), Carmen, V.-L. (Vleggeert-Lankamp), Victor, V. (Volovici), Voormolen, D.C. (Daphne), Peter, V. (Vulekovic), Zoltán, V. (Vámos), Derick, W. (Wade), Wang Kevin, K.W. (K. W.), Lei, W. (Wang), Lars, W. (Wessels), Eno, W. (Wildschut), Guy, W. (Williams), Lindsay, W. (Wilson), Winkler Maren, K.L. (K. L.), Stefan, W. (Wolf), Peter, Y. (Ylén), Alexander, Y. (Younsi), Menashe, Z. (Zaaroor), Yang, Z. (Zhihui), Agate, Z. (Ziverte), Fabrizio, Z. (Zumbo), van Essen, T.A. (Thomas A.), den Boogert, H.F. (Hugo F.), Cnossen, M.C. (Maryse), De Ruiter, G.C.W. (Godard C.W.), Haitsma, I. (Iain), Polinder, S. (Suzanne), Steyerberg, E.W. (Ewout), Menon, D.K. (David ), Maas, A.I.R. (Andrew), Lingsma, H.F. (Hester), Peul, W.C. (Wilco), Cecilia, A. (Ackerlund), Hadie, A. (Adams), Vanni, A. (Agnoletti), Judith, A. (Allanson), Krisztina, A. (Amrein), Norberto, A. (Andaluz), Nada, A. (Andelic), Lasse, A. (Andreassen), Azasevac, A. (Antun), Audny, A. (Anke), Anna, A. (Antoni), Hilko, A. (Ardon), Gérard, A. (Audibert), Kaspars, A. (Auslands), Philippe, A. (Azouvi), Luisa, A.M. (Azzolini Maria), Camelia, B. (Baciu), Rafael, B. (Badenes), Ronald, B. (Bartels), Pál, B. (Barzó), Ursula, B. (Bauerfeind), Romuald, B. (Beauvais), Ronny, B. (Beer), Javier, B.F. (Belda Francisco), Bo-Michael, B. (Bellander), Antonio, B. (Belli), Rémy, B. (Bellier), Habib, B. (Benali), Thierry, B. (Benard), Maurizio, B. (Berardino), Luigi, B. (Beretta), Christopher, B. (Beynon), Federico, B. (Bilotta), Harald, B. (Binder), Erta, B. (Biqiri), Morten, B. (Blaabjerg), den Hugo, B. (Boogert), Pierre, B. (Bouzat), Peter, B. (Bragge), Alexandra, B. (Brazinova), Vibeke, B. (Brinck), Joanne, B. (Brooker), Camilla, B. (Brorsson), Andras, B. (Buki), Monika, B. (Bullinger), Emiliana, C. (Calappi), Rosa, C.M. (Calvi Maria), Peter, C. (Cameron), Guillermo, C.L. (Carbayo Lozano), Marco, C. (Carbonara), Elsa, C. (Carise), Carpenter, K.L.H. (Keri L.H.), Castaño-León Ana, M. (M.), Francesco, C. (Causin), Giorgio, C. (Chevallard), Arturo, C. (Chieregato), Giuseppe, C. (Citerio), Maryse, C. (Cnossen), Mark, C. (Coburn), Jonathan, C. (Coles), Lizzie, C.-K. (Coles-Kemp), Johnny, C. (Collett), Cooper Jamie, D. (D.), Marta, C. (Correia), Amra, C. (Covic), Nicola, C. (Curry), Endre, C. (Czeiter), Marek, C. (Czosnyka), Claire, D.-F. (Dahyot-Fizelier), François, D. (Damas), Pierre, D. (Damas), Helen, D. (Dawes), Véronique, D.K. (De Keyser), Francesco, D.C. (Della Corte), Bart, D. (Depreitere), de Ruiter Godard, C.W. (C. W.), Dula, D. (Dilvesi), Shenghao, D. (Ding), Diederik, D. (Dippel), Abhishek, D. (Dixit), Emma, D. (Donoghue), Jens, D. (Dreier), Guy-Loup, D. (Dulière), George, E. (Eapen), Heiko, E. (Engemann), Ari, E. (Ercole), Patrick, E. (Esser), Erzsébet, E. (Ezer), Martin, F. (Fabricius), Feigin Valery, L. (L.), Junfeng, F. (Feng), Kelly, F. (Foks), Francesca, F. (Fossi), Gilles, F. (Francony), Ulderico, F. (Freo), Shirin, F. (Frisvold), Alex, F. (Furmanov), Pablo, G. (Gagliardo), Damien, G. (Galanaud), Dashiell, G. (Gantner), Guoyi, G. (Gao), Karin, G. (Geleijns), Pradeep, G. (George), Alexandre, G. (Ghuysen), Lelde, G. (Giga), Benoit, G. (Giraud), Ben, G. (Glocker), Jagos, G. (Golubovic), Gomez Pedro, A. (A.), Francesca, G. (Grossi), Gruen Russell, L. (L.), Deepak, G. (Gupta), Haagsma Juanita, A. (A.), Iain, H. (Haitsma), Hartings Jed, A. (A.), Raimund, H. (Helbok), Eirik, H. (Helseth), Daniel, H. (Hertle), Astrid, H. (Hoedemaekers), Stefan, H. (Hoefer), Lindsay, H. (Horton), Jilske, H. (Huijben), Hutchinson Peter, J. (J.), Kristine, H.A. (Håberg Asta), Bram, J. (Jacobs), Stefan, J. (Jankowski), Mike, J. (Jarrett), Bojan, J. (Jelaca), Ji-yao, J. (Jiang), Kelly, J. (Jones), Konstantinos, K. (Kamnitsas), Mladen, K. (Karan), Ari, K. (Katila), Maija, K. (Kaukonen), Thomas, K. (Kerforne), Riku, K. (Kivisaari), Kolias Angelos, G. (G.), Bálint, K. (Kolumbán), Erwin, K. (Kompanje), Ksenija, K. (Kolundzija), Daniel, K. (Kondziella), Lars-Owe, K. (Koskinen), Noémi, K. (Kovács), Alfonso, L. (Lagares), Linda, L. (Lanyon), Steven, L. (Laureys), Fiona, L. (Lecky), Christian, L. (Ledig), Rolf, L. (Lefering), Valerie, L. (Legrand), Jin, L. (Lei), Leon, L. (Levi), Roger, L. (Lightfoot), Hester, L. (Lingsma), Dirk, L. (Loeckx), Angels, L. (Lozano), Maas Andrew, I.R. (I. R.), Stephen, M.D. (MacDonald), Marc, M. (Maegele), Marek, M. (Majdan), Sebastian, M. (Major), Alex, M. (Manara), Geoffrey, M. (Manley), Didier, M. (Martin), Francisco, M.L. (Martin Leon), Costanza, M. (Martino), Armando, M. (Maruenda), Hugues, M. (Maréchal), Alessandro, M. (Masala), Julia, M. (Mattern), Charles, M.F. (McFadyen), Catherine, M.M. (McMahon), Béla, M. (Melegh), David, M. (Menon), Tomas, M. (Menovsky), Cristina, M.-K. (Morganti-Kossmann), Davide, M. (Mulazzi), Visakh, M. (Muraleedharan), Lynnette, M. (Murray), Holger, M. (Mühlan), Nandesh, N. (Nair), Ancuta, N. (Negru), David, N. (Nelson), Virginia, N. (Newcombe), Daan, N. (Nieboer), Quentin, N. (Noirhomme), József, N. (Nyirádi), Mauro, O. (Oddo), Annemarie, O. (Oldenbeuving), Matej, O. (Oresic), Fabrizio, O. (Ortolano), Aarno, P. (Palotie), Parizel Paul, M. (M.), Adriana, P. (Patruno), Jean-François, P. (Payen), Natascha, P. (Perera), Vincent, P. (Perlbarg), Paolo, P. (Persona), Wilco, P. (Peul), Anna, P.-K. (Piippo-Karjalainen), Sébastien, P.F. (Pili Floury), Matti, P. (Pirinen), Horia, P. (Ples), Antonia, P.M. (Poca Maria), Suzanne, P. (Polinder), Inigo, P. (Pomposo), Jussi, P. (Posti), Louis, P. (Puybasset), Andreea, R. (Radoi), Arminas, R. (Ragauskas), Rahul, R. (Raj), Malinka, R. (Rambadagalla), Ruben, R. (Real), Veronika, R. (Rehorčíková), Jonathan, R. (Rhodes), Samuli, R. (Ripatti), Saulius, R. (Rocka), Cecilie, R. (Roe), Olav, R. (Roise), Gerwin, R. (Roks), Jonathan, R. (Rosand), Jeffrey, R. (Rosenfeld), Christina, R. (Rosenlund), Guy, R. (Rosenthal), Rolf, R. (Rossaint), Sandra, R. (Rossi), Daniel, R. (Rueckert), Martin, R. (Rusnák), Marco, S. (Sacchi), Barbara, S. (Sahakian), Juan, S. (Sahuquillo), Oliver, S. (Sakowitz), Francesca, S. (Sala), Renan, S.-P. (Sanchez-Porras), Janos, S. (Sandor), Edgar, S. (Santos), Luminita, S. (Sasu), Davide, S. (Savo), Nadine, S. (Schäffer), Inger, S. (Schipper), Barbara, S.ß. (Schlößer), Silke, S. (Schmidt), Herbert, S. (Schoechl), Guus, S. (Schoonman), Frederik, S.R. (Schou Rico), Elisabeth, S. (Schwendenwein), Michael, S. (Schöll), Özcan, S. (Sir), Toril, S. (Skandsen), Lidwien, S. (Smakman), Dirk, S. (Smeets), Peter, S. (Smielewski), Abayomi, S. (Sorinola), Emmanuel, S. (Stamatakis), Simon, S. (Stanworth), Nicole, S. (Steinbüchel), Ana, S. (Stevanovic), Robert, S. (Stevens), William, S. (Stewart), Steyerberg Ewout, W. (W.), Nino, S. (Stocchetti), Nina, S. (Sundström), Anneliese, S. (Synnot), Silvio, T.F. (Taccone Fabio), Riikka, T. (Takala), Viktória, T. (Tamás), Päivi, T. (Tanskanen), Steven, T.M. (Taylor Mark), Braden, T.A. (Te Ao), Olli, T. (Tenovuo), Ralph, T. (Telgmann), Guido, T. (Teodorani), Alice, T. (Theadom), Matt, T. (Thomas), Dick, T. (Tibboel), Christos, T. (Tolias), Luaba, T.J.-F. (Tshibanda Jean-Flory), Tony, T. (Trapani), Maria, T.C. (Tudora Cristina), Peter, V. (Vajkoczy), Shirley, V. (Vallance), Egils, V. (Valeinis), der Steen Gregory, V. (Van), van der Mathieu, J. (Jagt), van der Joukje, N. (Naalt), van Dijck Jeroen, T.J.M. (T. J.M.), van Essen Thomas, A. (A.), Wim, V.H. (Van Hecke), van Caroline, H. (Heugten), Dominique, V.P. (Van Praag), Thijs, V.V. (Vande Vyvere), Julia, V.W. (Van Waesberghe), Audrey, V. (Vanhaudenhuyse), Alessia, V. (Vargiolu), Emmanuel, V. (Vega), Kimberley, V. (Velt), Jan, V. (Verheyden), Vespa Paul, M. (M.), Anne, V. (Vik), Rimantas, V. (Vilcinis), Giacinta, V. (Vizzino), Carmen, V.-L. (Vleggeert-Lankamp), Victor, V. (Volovici), Voormolen, D.C. (Daphne), Peter, V. (Vulekovic), Zoltán, V. (Vámos), Derick, W. (Wade), Wang Kevin, K.W. (K. W.), Lei, W. (Wang), Lars, W. (Wessels), Eno, W. (Wildschut), Guy, W. (Williams), Lindsay, W. (Wilson), Winkler Maren, K.L. (K. L.), Stefan, W. (Wolf), Peter, Y. (Ylén), Alexander, Y. (Younsi), Menashe, Z. (Zaaroor), Yang, Z. (Zhihui), Agate, Z. (Ziverte), and Fabrizio, Z. (Zumbo)

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.

Published
2018
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