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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.
Variation in neurosurgical management of traumatic brain injury: a survey in 68 centers participating in the CENTER-TBI study
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.
Membro del Collaboration Group
;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.;Jonathan 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.;Peter 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.
2019-01-01
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.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.11768/88894
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simulazione ASN
Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione. La simulazione si basa sui dati IRIS e sugli indicatori bibliometrici alla data indicata e non tiene conto di eventuali periodi di congedo obbligatorio, che in sede di domanda ASN danno diritto a incrementi percentuali dei valori. La simulazione può differire dall'esito di un’eventuale domanda ASN sia per errori di catalogazione e/o dati mancanti in IRIS, sia per la variabilità dei dati bibliometrici nel tempo. Si consideri che Anvur calcola i valori degli indicatori all'ultima data utile per la presentazione delle domande.
La presente simulazione è stata realizzata sulla base delle specifiche raccolte sul tavolo ER del Focus Group IRIS coordinato dall’Università di Modena e Reggio Emilia e delle regole riportate nel DM 589/2018 e allegata Tabella A. Cineca, l’Università di Modena e Reggio Emilia e il Focus Group IRIS non si assumono alcuna responsabilità in merito all’uso che il diretto interessato o terzi faranno della simulazione. Si specifica inoltre che la simulazione contiene calcoli effettuati con dati e algoritmi di pubblico dominio e deve quindi essere considerata come un mero ausilio al calcolo svolgibile manualmente o con strumenti equivalenti.