Brain Trauma Foundation Guideline Compliance: Results of a Multidisciplinary, International Survey

Hirschi, Ryan; Rommel, Casey; Letsinger, Joshua; Nirula, Raminder; Hawryluk, Gregory

doi:10.1016/j.wneu.2018.04.215

Cited by 9 publications

(4 citation statements)

References 18 publications

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“…8,34 Most of these guidelines, developed in high and low-middle income countries do not fill the gaps of different scenarios in real-life situations due to the methodology itself, attached to the evidence-based methodological science. [40][41][42][43][44] In real circumstances, not all the resources are always available on time, especially in LMICs. 45 The present effort is focused on filling these gaps with a mixed methods approach combining evidence-based recommendations and expert opinion where there is no evidence-based medicine to develop helpful recommendations for real-life situations in different context with resources level variation.…”

Section: Discussionmentioning

confidence: 99%

Recommendations of the Colombian Consensus Committee for the Management of Traumatic Brain Injury in Prehospital, Emergency Department, Surgery, and Intensive Care (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol [BOOTStraP])

Rubiano

Vera

Montenegro³

et al. 2020

J Neurosci Rural Pract

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Abstract Background Traumatic brain injury (TBI) is a global public health problem. In Colombia, it is estimated that 70% of deaths from violence and 90% of deaths from road traffic accidents are TBI related. In the year 2014, the Ministry of Health of Colombia funded the development of a clinical practice guideline (CPG) for the diagnosis and treatment of adult patients with severe TBI. A critical barrier to the widespread implementation was identified—that is, the lack of a specific protocol that spans various levels of resources and complexity across the four treatment phases. The objective of this article is to present the process and recommendations for the management of patients with TBI in various resource environments, across the treatment phases of prehospital care, emergency department (ED), surgery, and intensive care unit. Methods Using the Delphi methodology, a consensus of 20 experts in emergency medicine, neurosurgery, prehospital care, and intensive care nationwide developed recommendations based on 13 questions for the management of patients with TBI in Colombia. Discussion It is estimated that 80% of the global population live in developing economies where access to resources required for optimum treatment is limited. There is limitation for applications of CPGs recommendations in areas where there is low availability or absence of resources for integral care. Development of mixed methods consensus, including evidence review and expertise points of good clinical practices can fill gaps in application of CPGs. BOOTStraP (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol) is intended to be a practical handbook for care providers to use to treat TBI patients with whatever resources are available. Results Stratification of recommendations for interventions according to the availability of the resources on different stages of integral care is a proposed method for filling gaps in actual evidence, to organize a better strategy for interventions in different real-life scenarios. We develop 10 algorithms of management for building TBI protocols based on expert consensus to articulate treatment options in prehospital care, EDs, neurological surgery, and intensive care, independent of the level of availability of resources for care.

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Section: Discussionmentioning

confidence: 99%

Recommendations of the Colombian Consensus Committee for the Management of Traumatic Brain Injury in Prehospital, Emergency Department, Surgery, and Intensive Care (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol [BOOTStraP])

Rubiano

Vera

Montenegro³

et al. 2020

J Neurosci Rural Pract

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“…Process measurement and compliance is important to increase the quality of care and therefore value, as even when evidence-based best practices are identified they may not be implemented. For example, previous studies have shown that few institutions “always” follow the Brain Trauma Foundation guidelines8 when managing patients with traumatic brain injury, nearly half of anesthesiologists were unaware of delirium prevention guidelines,9 and higher compliance with Enhanced Recovery After Surgery (ERAS) protocols was associated with improved outcomes 10. Ultimately, QI needs to be linked to relevant outcomes and cost efficiency to effectively drive value 6…”

Section: Value-based Health Care and Qi: Concepts And Frameworkmentioning

confidence: 99%

Value-based Care and Quality Improvement in Perioperative Neuroscience

Luoma

Flexman

2022

Journal of Neurosurgical Anesthesiology

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Value-based care and quality improvement are related concepts used to measure and improve clinical care. Value-based care represents the relationship between the incremental gain in outcome for patients and cost efficiency. It is achieved by identifying outcomes that are important to patients, codesigning solutions using multidisciplinary teams, measuring both outcomes and costs to drive further improvements, and developing partnerships across the health system. Quality improvement is focused on process improvement and compliance with best practice, and often uses "Plan-Do-Study-Act" cycles to identify, test, and implement change. Validated, standardized core outcome sets for perioperative neuroscience are currently lacking, but neuroanesthesiologists can consider using traditional clinical indicators, patient-reported outcomes measures, and perioperative core outcome measures. Several examples of bundled care solutions have been successfully implemented in perioperative neuroscience to increase value; for example, enhanced recovery for spine surgery, delirium reduction pathways, and same-day discharge craniotomy. This review proposes potential individualand system-based solutions to address barriers to value-based care and quality improvement in perioperative neuroscience.

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“…The BTF's guidelines have helped to reduce mortality and variability in TBI care around the world. 33 Probably the success of the early BTF guidelines can be attributed to eliminating practices that were detrimental such as hyperventilation, administration of steroids and under resuscitation due to a fear of brain edema. Moreover, implementation of the BTF guidelines has been associated with a reduction in the cost of care.…”

Section: Impact Of the Guidelinesmentioning

confidence: 99%

“…Despite the reported benefits, compliance with the BTF guidelines remains variable in America and around the world. [35][36][37] Level one trauma centers are more likely to implement the guidelines, 33,38 and recommendations supported by stronger evidence are more likely to be put into practice. 38 Efforts to improve implementation of best practice guidelines may include educational efforts 39 and crafting practical recommendations that are more amenable to clinical use.…”

Section: Impact Of the Guidelinesmentioning

confidence: 99%

Evolution and Impact of the Brain Trauma Foundation Guidelines

Hawryluk¹,

Ghajar²

2021

Neurosurg.

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The Brain Trauma Foundation (BTF) Guidelines for the Management of Severe Head Injury were the first clinical practice guidelines published by any surgical specialty. These guidelines have earned a reputation for rigor and have been widely adopted around the world. Implementation of these guidelines has been associated with a 50% reduction in mortality and reduced costs of patient care. Over their 25-yr history the traumatic brain injury (TBI) guidelines have been expanded, refined, and made increasingly more rigorous in conjunction with new clinical evidence and evolving methodologic standards. Here, we discuss the history and accomplishments of BTF guidelines for TBI as well as their limitations. We also discuss planned changes to future TBI guidelines intended to increase their utility and positive impact in an evolving medical landscape. Perhaps the greatest limitation of TBI guidelines now is the lack of high-quality clinical research as well as novel diagnostics and treatments with which to generate substantially new recommendations.

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Brain Trauma Foundation Guideline Compliance: Results of a Multidisciplinary, International Survey

Cited by 9 publications

References 18 publications

Recommendations of the Colombian Consensus Committee for the Management of Traumatic Brain Injury in Prehospital, Emergency Department, Surgery, and Intensive Care (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol [BOOTStraP])

Recommendations of the Colombian Consensus Committee for the Management of Traumatic Brain Injury in Prehospital, Emergency Department, Surgery, and Intensive Care (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol [BOOTStraP])

Value-based Care and Quality Improvement in Perioperative Neuroscience

Evolution and Impact of the Brain Trauma Foundation Guidelines

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