Relationship between guideline adherence and outcomes in severe traumatic brain injury

Abstract

Introduction Traumatic brain injury (TBI) is a leading cause of death and morbidity worldwide. Evidence-based guidelines for managing severe TBI have been available for over 25 years. However, adherence to guidelines remains variable despite evidence highlighting improvement in outcomes with individual recommendations. There is limited evidence to support a superior outcome with compliance to whole sets of recommendations. The aim of this review was to determine whether adherence to TBI guidelines as a package improves outcomes in adults and paediatric patients with severe TBI. Methods A structured literature search was conducted using the MEDLINE®, Embase™, PubMed and CINAHL® (Cumulative Index to Nursing and Allied Health Literature) databases. Studies were considered eligible for inclusion in this review if they were quantitative studies investigating the use of TBI guidelines in relation to one or more of the following outcomes: mortality, functional outcome and length of hospital stay. Results Nine cohort studies were identified that fulfilled the inclusion criteria and answered the clinical question. A review of these papers was conducted. Conclusions Mortality after severe TBI improves with increasing adherence to evidence-based guidelines in both adults and children. The evidence also suggests that compliance with guideline recommendations results in improved functional outcomes and reduced length of hospital stay.

Equity considerations in clinical practice guidelines for traumatic brain injury and homelessness: a systematic review

“…10 There is evidence that adherence to TBI CPGs leads to lower mortality, reduced length of stay in hospital, and improved functional outcomes, particularly among adults and children with severe TBI. 11 CPGs are often developed with a focus on treatment effectiveness and cost-effectiveness, 12 without regard for equity (i.e., “the absence of unfair and avoidable or remediable differences on health amongst social groups 12 , 13 ”) or health inequities. 4 , 12 Thus, recommendations in CPGs may not always be applicable or beneficial to disadvantaged groups who encounter health inequities, including individuals experiencing homelessness.…”