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New guidelines issued for patients with severe traumatic brain injury

Guidelines previously updated once a decade now will be modified as discoveries are made
Nancy Carney, Ph.D.
Nancy Carney, Ph.D.

A panel of leading experts today issued the 4th Edition of the Guidelines for the Management of Severe Traumatic Brain Injury.

The updated guidelines provide recommendations for 18 monitoring and treatment topics for patients with severe traumatic brain injuries, or TBI, including surgical procedures, the use of monitors that measure intracranial pressure, preventing and treating brain swelling, and nutrition.

National experts in neurosurgery, neuro-intensive care, and neuro-trauma, led by the Pacific Northwest Evidence-based Practice Center at OHSU and the Brain Trauma Foundation, spent six years evaluating research studies and developing evidence-based recommendations for the in-hospital management of severe traumatic brain injury. The executive summary was published online today, ahead of print, in the journalNeurosurgery. This summary contains links to the comprehensive guidelines document hosted by the Brain Trauma Foundation. This is the first update since the third edition was published in 2007.

Failure to follow the guidelines can be lethal for the approximately 2.5 million Americans with traumatic brain injury every year and expensive for the health care system. A 2007 study by the Centers for Disease Control and Prevention estimated an annual reduction in mortality of 3,607 lives with closer adherence to the guidelines, and an annual reduction of lifetime societal costs of $3.84 billion.

Severe TBIs contribute to 30 percent of all injury-related deaths in the U.S. TBIs that are fatal or require hospitalization account for 90 percent of the $76.5 billion in annual costs for TBI.

Going forward, the guidelines will be updated as new scientific research becomes available.

“In the past, the guidelines were updated about once a decade,” said lead author Nancy Carney, Ph.D., research associate professor at OHSU. “From here forward, we are implementing a system which will provide updates in real time, as new information becomes available. This is an important improvement in the delivery of evidence-based information to the brain trauma community, and should result in better outcomes for patients.”

The original guidelines, published in 1996, were the first ever evidence-based guidelines in any branch of surgery. Now these guidelines are translated and distributed around the world. Recently, China endorsed the guidelines after consulting with Dr. Ross Bullock, the chief of the Brain Trauma Foundation’s medical advisory board and a faculty member at the University of Miami.

The Department of Medical Informatics and Clinical Epidemiology at OHSU has been the home for the Brain Trauma Foundation’s Center for Guidelines Management for 12 years, with BTF providing funding for the work through award number BTECOHSU. During that time the center has generated TBI guidelines for topics such as pre-hospital management, pediatric TBI, severe TBI, and field combat management of TBI.

The guidelines are based in part upon work supported by the U.S. Army Contracting Command, Aberdeen Proving Ground, Natick Contracting Division [NHRC BAA 13-001 #W911QY-13-R-0063 PI: Ghajar, Jamshid, Brain Trauma Evidence-based Consortium.


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