Suboptimal compliance with evidence-based guidelines in patients with traumatic brain injuries: Clinical article

Shahid Shafi, Sunni A. Barnes, D. Millar, Justin Sobrino, Rustam Kudyakov, Candice Berryman, Nadine Rayan, Rosemary Dubiel, Raul Coimbra, Louis J. Magnotti, Gary Vercruysse, Lynette A. Scherer, Gregory Jurkovich, Raminder Nirula

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Object. Evidence-based management (EBM) guidelines for severe traumatic brain injuries (TBIs) were promulgated decades ago. However, the extent of their adoption into bedside clinical practices is not known. The purpose of this study was to measure compliance with EBM guidelines for management of severe TBI and its impact on patient outcome. Methods. This was a retrospective study of blunt TBI (11 Level I trauma centers, study period 2008-2009, n = 2056 patients). Inclusion criteria were an admission Glasgow Coma Scale score ≤ 8 and a CT scan showing TBI, excluding patients with nonsurvivable injuries - that is, head Abbreviated Injury Scale score of 6. The authors measured compliance with 6 nonoperative EBM processes (endotracheal intubation, resuscitation, correction of coagulopathy, intracranial pressure monitoring, maintaining cerebral perfusion pressure ≥ 50 cm H2O, and discharge to rehabilitation). Compliance rates were calculated for each center using multivariate regression to adjust for patient demographics, physiology, injury severity, and TBI severity. Results. The overall compliance rate was 73%, and there was wide variation among centers. Only 3 centers achieved a compliance rate exceeding 80%. Risk-adjusted compliance was worse than average at 2 centers, better than average at 1, and the remainder were average. Multivariate analysis showed that increased adoption of EBM was associated with a reduced mortality rate (OR 0.88; 95% CI 0.81-0.96, p < 0.005). Conclusions. Despite widespread dissemination of EBM guidelines, patients with severe TBI continue to receive inconsistent care. Barriers to adoption of EBM need to be identified and mitigated to improve patient outcomes.

Original languageEnglish (US)
Pages (from-to)773-777
Number of pages5
JournalJournal of Neurosurgery
Volume120
Issue number3
DOIs
StatePublished - 2014

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Guidelines
Cerebrovascular Circulation
Abbreviated Injury Scale
Glasgow Coma Scale
Intratracheal Intubation
Trauma Centers
Wounds and Injuries
Intracranial Pressure
Craniocerebral Trauma
Resuscitation
Compliance
Traumatic Brain Injury
Rehabilitation
Multivariate Analysis
Retrospective Studies
Demography
Mortality

Keywords

  • Evidence-based management
  • Quality chasm
  • Quality of care
  • Traumatic brain injury
  • Variations in care

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Shafi, S., Barnes, S. A., Millar, D., Sobrino, J., Kudyakov, R., Berryman, C., ... Nirula, R. (2014). Suboptimal compliance with evidence-based guidelines in patients with traumatic brain injuries: Clinical article. Journal of Neurosurgery, 120(3), 773-777. https://doi.org/10.3171/2013.12.JNS132151

Suboptimal compliance with evidence-based guidelines in patients with traumatic brain injuries : Clinical article. / Shafi, Shahid; Barnes, Sunni A.; Millar, D.; Sobrino, Justin; Kudyakov, Rustam; Berryman, Candice; Rayan, Nadine; Dubiel, Rosemary; Coimbra, Raul; Magnotti, Louis J.; Vercruysse, Gary; Scherer, Lynette A.; Jurkovich, Gregory; Nirula, Raminder.

In: Journal of Neurosurgery, Vol. 120, No. 3, 2014, p. 773-777.

Research output: Contribution to journalArticle

Shafi, S, Barnes, SA, Millar, D, Sobrino, J, Kudyakov, R, Berryman, C, Rayan, N, Dubiel, R, Coimbra, R, Magnotti, LJ, Vercruysse, G, Scherer, LA, Jurkovich, G & Nirula, R 2014, 'Suboptimal compliance with evidence-based guidelines in patients with traumatic brain injuries: Clinical article', Journal of Neurosurgery, vol. 120, no. 3, pp. 773-777. https://doi.org/10.3171/2013.12.JNS132151
Shafi, Shahid ; Barnes, Sunni A. ; Millar, D. ; Sobrino, Justin ; Kudyakov, Rustam ; Berryman, Candice ; Rayan, Nadine ; Dubiel, Rosemary ; Coimbra, Raul ; Magnotti, Louis J. ; Vercruysse, Gary ; Scherer, Lynette A. ; Jurkovich, Gregory ; Nirula, Raminder. / Suboptimal compliance with evidence-based guidelines in patients with traumatic brain injuries : Clinical article. In: Journal of Neurosurgery. 2014 ; Vol. 120, No. 3. pp. 773-777.
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abstract = "Object. Evidence-based management (EBM) guidelines for severe traumatic brain injuries (TBIs) were promulgated decades ago. However, the extent of their adoption into bedside clinical practices is not known. The purpose of this study was to measure compliance with EBM guidelines for management of severe TBI and its impact on patient outcome. Methods. This was a retrospective study of blunt TBI (11 Level I trauma centers, study period 2008-2009, n = 2056 patients). Inclusion criteria were an admission Glasgow Coma Scale score ≤ 8 and a CT scan showing TBI, excluding patients with nonsurvivable injuries - that is, head Abbreviated Injury Scale score of 6. The authors measured compliance with 6 nonoperative EBM processes (endotracheal intubation, resuscitation, correction of coagulopathy, intracranial pressure monitoring, maintaining cerebral perfusion pressure ≥ 50 cm H2O, and discharge to rehabilitation). Compliance rates were calculated for each center using multivariate regression to adjust for patient demographics, physiology, injury severity, and TBI severity. Results. The overall compliance rate was 73{\%}, and there was wide variation among centers. Only 3 centers achieved a compliance rate exceeding 80{\%}. Risk-adjusted compliance was worse than average at 2 centers, better than average at 1, and the remainder were average. Multivariate analysis showed that increased adoption of EBM was associated with a reduced mortality rate (OR 0.88; 95{\%} CI 0.81-0.96, p < 0.005). Conclusions. Despite widespread dissemination of EBM guidelines, patients with severe TBI continue to receive inconsistent care. Barriers to adoption of EBM need to be identified and mitigated to improve patient outcomes.",
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AU - Shafi, Shahid

AU - Barnes, Sunni A.

AU - Millar, D.

AU - Sobrino, Justin

AU - Kudyakov, Rustam

AU - Berryman, Candice

AU - Rayan, Nadine

AU - Dubiel, Rosemary

AU - Coimbra, Raul

AU - Magnotti, Louis J.

AU - Vercruysse, Gary

AU - Scherer, Lynette A.

AU - Jurkovich, Gregory

AU - Nirula, Raminder

PY - 2014

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N2 - Object. Evidence-based management (EBM) guidelines for severe traumatic brain injuries (TBIs) were promulgated decades ago. However, the extent of their adoption into bedside clinical practices is not known. The purpose of this study was to measure compliance with EBM guidelines for management of severe TBI and its impact on patient outcome. Methods. This was a retrospective study of blunt TBI (11 Level I trauma centers, study period 2008-2009, n = 2056 patients). Inclusion criteria were an admission Glasgow Coma Scale score ≤ 8 and a CT scan showing TBI, excluding patients with nonsurvivable injuries - that is, head Abbreviated Injury Scale score of 6. The authors measured compliance with 6 nonoperative EBM processes (endotracheal intubation, resuscitation, correction of coagulopathy, intracranial pressure monitoring, maintaining cerebral perfusion pressure ≥ 50 cm H2O, and discharge to rehabilitation). Compliance rates were calculated for each center using multivariate regression to adjust for patient demographics, physiology, injury severity, and TBI severity. Results. The overall compliance rate was 73%, and there was wide variation among centers. Only 3 centers achieved a compliance rate exceeding 80%. Risk-adjusted compliance was worse than average at 2 centers, better than average at 1, and the remainder were average. Multivariate analysis showed that increased adoption of EBM was associated with a reduced mortality rate (OR 0.88; 95% CI 0.81-0.96, p < 0.005). Conclusions. Despite widespread dissemination of EBM guidelines, patients with severe TBI continue to receive inconsistent care. Barriers to adoption of EBM need to be identified and mitigated to improve patient outcomes.

AB - Object. Evidence-based management (EBM) guidelines for severe traumatic brain injuries (TBIs) were promulgated decades ago. However, the extent of their adoption into bedside clinical practices is not known. The purpose of this study was to measure compliance with EBM guidelines for management of severe TBI and its impact on patient outcome. Methods. This was a retrospective study of blunt TBI (11 Level I trauma centers, study period 2008-2009, n = 2056 patients). Inclusion criteria were an admission Glasgow Coma Scale score ≤ 8 and a CT scan showing TBI, excluding patients with nonsurvivable injuries - that is, head Abbreviated Injury Scale score of 6. The authors measured compliance with 6 nonoperative EBM processes (endotracheal intubation, resuscitation, correction of coagulopathy, intracranial pressure monitoring, maintaining cerebral perfusion pressure ≥ 50 cm H2O, and discharge to rehabilitation). Compliance rates were calculated for each center using multivariate regression to adjust for patient demographics, physiology, injury severity, and TBI severity. Results. The overall compliance rate was 73%, and there was wide variation among centers. Only 3 centers achieved a compliance rate exceeding 80%. Risk-adjusted compliance was worse than average at 2 centers, better than average at 1, and the remainder were average. Multivariate analysis showed that increased adoption of EBM was associated with a reduced mortality rate (OR 0.88; 95% CI 0.81-0.96, p < 0.005). Conclusions. Despite widespread dissemination of EBM guidelines, patients with severe TBI continue to receive inconsistent care. Barriers to adoption of EBM need to be identified and mitigated to improve patient outcomes.

KW - Evidence-based management

KW - Quality chasm

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KW - Traumatic brain injury

KW - Variations in care

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