Variation in neurosurgical management of traumatic brain injury: a survey in 68 centers participating in the CENTER-TBI study

van Essen, Thomas A; den Boogert, Hugo F; Cnossen, Maryse C; de Ruiter, Godard CW; Haitsma, Iain; Polinder, Suzanne; Steyerberg, Ewout W; Menon, David; Maas, Andrew IR; Lingsma, Hester F; Peul, Wilco C; Cecilia, Ackerlund; Hadie, Adams; Vanni, Agnoletti; Judith, Allanson; Krisztina, Amrein; Norberto, Andaluz; Nada, Andelic; Lasse, Andreassen; Azasevac, Antun; Audny, Anke; Anna, Antoni; Hilko, Ardon; Gerard, Audibert; Kaspars, Auslands; Philippe, Azouvi; Luisa, Azzolini Maria; Camelia, Baciu; Rafael, Badenes; Ronald, Bartels; Pal, Barzo; Ursula, Bauerfeind; Romuald, Beauvais; Ronny, Beer; Francisco Javier, Belda; Bo-Michael, Bellander; Antonio, Belli; Remy, Bellier; Habib, Benali; Thierry, Benard; Maurizio, Berardino; Luigi, Beretta; Christopher, Beynon; Federico, Bilotta; Harald, Binder; Erta, Biqiri; Morten, Blaabjerg; Hugo, den Boogert; Pierre, Bouzat; Peter, Bragge; Alexandra, Brazinova; Vibeke, Brinck; Joanne, Brooker; Camilla, Brorsson; Andras, Buki; Monika, Bullinger; Emiliana, Calappi; Rosa, Calvi Maria; Peter, Cameron; Lozano Guillermo, Carbayo; Marco, Carbonara; Elsa, Carise; Carpenter, K; Ana M, Castano-Leon; Francesco, Causin; Giorgio, Chevallard; Arturo, Chieregato; Giuseppe, Citerio; Maryse, Cnossen; Mark, Coburn; Jonathan, Coles; Lizzie, Coles-Kemp; Johnny, Collett; Jamie, Cooper D; Marta, Correia; Amra, Covic; Nicola, Curry; Endre, Czeiter; Marek, Czosnyka; Claire, Dahyot-Fizelier; Francois, Damas; Pierre, Damas; Helen, Dawes; Veronique, De Keyser; Francesco, Della Corte; Bart, Depreitere; Godard, de Ruiter CW; Dula, Dilvesi; Ding, Shenghao; Diederik, Dippel; Abhishek, Dixit; Emma, Donoghue; Jens, Dreier; Guy-Loup, Duliere; George, Eapen; Heiko, Engemann; Ari, Ercole; Patrick, Esser; Erzsebet, Ezer; Martin, Fabricius; Valery, Feigin L; Feng, Junfeng; Kelly, Foks; Francesca, Fossi; Gilles, Francony; Ulderico, Freo; Shirin, Frisvold; Alex, Furmanov; Pablo, Gagliardo; Damien, Galanaud; Dashiell, Gantner; Gao, Guoyi; Karin, Geleijns; Pradeep, George; Alexandre, Ghuysen; Lelde, Giga; Benoit, Giraud; Ben, Glocker; Jagos, Golubovic; Pedro, Gomez A; Francesca, Grossi; Russell, Gruen L; Deepak, Gupta; Juanita, Haagsma A; Iain, Haitsma; Jed, Hartings A; Raimund, Helbok; Eirik, Helseth; Daniel, Hertle; Astrid, Hoedemaekers; Stefan, Hoefer; Lindsay, Horton; Jilske, Huijben; Peter, Hutchinson J; Kristine, Haberg Asta; Bram, Jacobs; Stefan, Jankowski; Mike, Jarrett; Bojan, Jelaca; Jiang, Ji-yao; Kelly, Jones; Konstantinos, Kamnitsas; Mladen, Karan; Ari, Katila; Maija, Kaukonen; Thomas, Kerforne; Riku, Kivisaari; Angelos, Kolias G; Balint, Kolumban; Erwin, Kompanje; Ksenija, Kolundzija; Daniel, Kondziella; Lars-Owe, Koskinen; Noemi, Kovacs; Alfonso, Lagares; Linda, Lanyon; Steven, Laureys; Fiona, Lecky; Christian, Ledig; Rolf, Lefering; Valerie, Legrand; Jin, Lei; Leon, Levi; Roger, Lightfoot; Hester, Lingsma; Dirk, Loeckx; Angels, Lozano; Andrew, Maas IR; Stephen, MacDonald; Marc, Maegele; Marek, Majdan; Sebastian, Major; Alex, Manara; Geoffrey, Manley; Didier, Martin; Francisco, Martin Leon; Costanza, Martino; Armando, Maruenda; Hugues, Marechal; Alessandro, Masala; Julia, Mattern; Charles, McFadyen; Catherine, McMahon; Bela, Melegh; David, Menon; Tomas, Menovsky; Cristina, Morganti-Kossmann; Davide, Mulazzi; Visakh, Muraleedharan; Lynnette, Murray; Holger, Muehlan; Nandesh, Nair; Ancuta, Negru; David, Nelson; Virginia, Newcombe; Daan, Nieboer; Quentin, Noirhomme; Jozsef, Nyiradi; Mauro, Oddo; Annemarie, Oldenbeuving; Matej, Oresic; Fabrizio, Ortolano; Aarno, Palotie; Paul, Parizel M; Adriana, Patruno; Jean-Francois, Payen; Natascha, Perera; Vincent, Perlbarg; Paolo, Persona; PeulWilco,; Anna, Piippo-Karjalainen; Sebastien, Pili Floury; Matti, Pirinen; Horia, Ples; Maria Antonia, Poca; Suzanne, Polinder; Inigo, Pomposo; Jussi, Posti; Louis, Puybasset; Andreea, Radoi; Arminas, Ragauskas; Rahul, Raj; Malinka, Rambadagalla; Ruben, Real; Veronika, Rehorcikova; Jonathan, Rhodes; Samuli, Ripatti; Saulius, Rocka; Cecilie, Roe; Olav, Roise; Gerwin, Roks; Jonathan, Rosand; Jeffrey, Rosenfeld; Christina, Rosenlund; Guy, Rosenthal; Rolf, Rossaint; Sandra, Rossi; Daniel, Rueckert; Martin, Rusnak; Marco, Sacchi; Barbara, Sahakian; Juan, Sahuquillo; Oliver, Sakowitz; Francesca, Sala; Renan, Sanchez-Porras; Janos, Sandor; Edgar, Santos; Luminita, Sasu; Davide, Savo; Nadine, Schaeffer; Inger, Schipper; Barbara, Schloesser; Silke, Schmidt; Herbert, Schoechl; Guus, Schoonman; Frederik, Schou Rico; Elisabeth, Schwendenwein; Michael, Schoell; Ozcan, Sir; Toril, Skandsen; Lidwien, Smakman; Dirk, Smeets; Peter, Smielewski; Abayomi, Sorinola; Emmanuel, Stamatakis; Simon, Stanworth; Nicole, Steinbuechel; Ana, Stevanovic; Robert, Stevens; William, Stewart; Ewout, Steyerberg W; Nino, Stocchetti; Nina, Sundstrom; Anneliese, Synnot; Fabio Silvio, Taccone; Riikka, Takala; Viktoria, Tamas; Paivi, Tanskanen; Steven, Taylor Mark; Braden, Te Ao; Olli, Tenovuo; Ralph, Telgmann; Guido, Teodorani; Alice, Theadom; Matt, Thomas; Dick, Tibboel; Christos, Tolias; Luaba, Tshibanda Jean-Flory; Tony, Trapani; Maria, Tudora Cristina; Peter, Vajkoczy; Shirley, Vallance; Egils, Valeinis; Gregory, Van der Steen; Mathieu, Van der Jagt; Joukje, Van der Naalt; Jeroen, van Dijck TJM; Thomas, Van Essen A; Wim, Van Hecke; Caroline, van Heugten; Dominique, Van Praag; Thijs, Vande Vyvere; Julia, Van Waesberghe; Audrey, Vanhaudenhuyse; Alessia, Vargiolu; Emmanuel, Vega; Kimberley, Velt; Jan, Verheyden; Paul, Vespa M; Anne, Vik; Rimantas, Vilcinis; Giacinta, Vizzino; Carmen, Vleggeert-Lankamp; Victor, Volovici; Daphne, Voormolen; Peter, Vulekovic; Zoltan, Vamos; Derick, Wade; Kevin, Wang KW; Lei, Wang; Lars, Wessels; Eno, Wildschut; Guy, Williams; Lindsay, Wilson; Maren, Winkler KL; Stefan, Wolf; Peter, Ylen; Alexander, Younsi; Menashe, Zaaroor; Yang, Zhihui; Agate, Ziverte; Fabrizio, Zumbo

doi:10.1007/s00701-018-3761-z

Variation in neurosurgical management of traumatic brain injury: a survey in 68 centers participating in the CENTER-TBI study

Author:

van Essen, Thomas A

den Boogert, Hugo F ; Cnossen, Maryse C ; de Ruiter, Godard CW ; Haitsma, Iain ; Polinder, Suzanne ; Steyerberg, Ewout W ; Menon, David ; Maas, Andrew IR ; Lingsma, Hester F ; Peul, Wilco C ; Cecilia, Ackerlund ; Hadie, Adams ; Vanni, Agnoletti ; Judith, Allanson ; Krisztina, Amrein ; Norberto, Andaluz ; Nada, Andelic ; Lasse, Andreassen ; Azasevac, Antun ; Audny, Anke ; Anna, Antoni ; Hilko, Ardon ; Gerard, Audibert ; Kaspars, Auslands ; Philippe, Azouvi ; Luisa, Azzolini Maria ; Camelia, Baciu ; Rafael, Badenes ; Ronald, Bartels ; Pal, Barzo ; Ursula, Bauerfeind ; Romuald, Beauvais ; Ronny, Beer ; Francisco Javier, Belda ; Bo-Michael, Bellander ; Antonio, Belli ; Remy, Bellier ; Habib, Benali ; Thierry, Benard ; Maurizio, Berardino ; Luigi, Beretta ; Christopher, Beynon ; Federico, Bilotta ; Harald, Binder ; Erta, Biqiri ; Morten, Blaabjerg ; Hugo, den Boogert ; Pierre, Bouzat ; Peter, Bragge ; Alexandra, Brazinova ; Vibeke, Brinck ; Joanne, Brooker ; Camilla, Brorsson ; Andras, Buki ; Monika, Bullinger ; Emiliana, Calappi ; Rosa, Calvi Maria ; Peter, Cameron ; Lozano Guillermo, Carbayo ; Marco, Carbonara ; Elsa, Carise ; Carpenter, K ; Ana M, Castano-Leon ; Francesco, Causin ; Giorgio, Chevallard ; Arturo, Chieregato ; Giuseppe, Citerio ; Maryse, Cnossen ; Mark, Coburn ; Jonathan, Coles ; Lizzie, Coles-Kemp ; Johnny, Collett ; Jamie, Cooper D ; Marta, Correia ; Amra, Covic ; Nicola, Curry ; Endre, Czeiter ; Marek, Czosnyka ; Claire, Dahyot-Fizelier ; Francois, Damas ; Pierre, Damas ; Helen, Dawes ; Veronique, De Keyser ; Francesco, Della Corte ; Bart, Depreitere ; Godard, de Ruiter CW ; Dula, Dilvesi ; Ding, Shenghao ; Diederik, Dippel ; Abhishek, Dixit ; Emma, Donoghue ; Jens, Dreier ; Guy-Loup, Duliere ; George, Eapen ; Heiko, Engemann ; Ari, Ercole ; Patrick, Esser ; Erzsebet, Ezer ; Martin, Fabricius ; Valery, Feigin L ; Feng, Junfeng ; Kelly, Foks ; Francesca, Fossi ; Gilles, Francony ; Ulderico, Freo ; Shirin, Frisvold ; Alex, Furmanov ; Pablo, Gagliardo ; Damien, Galanaud ; Dashiell, Gantner ; Gao, Guoyi ; Karin, Geleijns ; Pradeep, George ; Alexandre, Ghuysen ; Lelde, Giga ; Benoit, Giraud ; Ben, Glocker ; Jagos, Golubovic ; Pedro, Gomez A ; Francesca, Grossi ; Russell, Gruen L ; Deepak, Gupta ; Juanita, Haagsma A ; Iain, Haitsma ; Jed, Hartings A ; Raimund, Helbok ; Eirik, Helseth ; Daniel, Hertle ; Astrid, Hoedemaekers ; Stefan, Hoefer ; Lindsay, Horton ; Jilske, Huijben ; Peter, Hutchinson J ; Kristine, Haberg Asta ; Bram, Jacobs ; Stefan, Jankowski ; Mike, Jarrett ; Bojan, Jelaca ; Jiang, Ji-yao ; Kelly, Jones ; Konstantinos, Kamnitsas ; Mladen, Karan ; Ari, Katila ; Maija, Kaukonen ; Thomas, Kerforne ; Riku, Kivisaari ; Angelos, Kolias G ; Balint, Kolumban ; Erwin, Kompanje ; Ksenija, Kolundzija ; Daniel, Kondziella ; Lars-Owe, Koskinen ; Noemi, Kovacs ; Alfonso, Lagares ; Linda, Lanyon ; Steven, Laureys ; Fiona, Lecky ; Christian, Ledig ; Rolf, Lefering ; Valerie, Legrand ; Jin, Lei ; Leon, Levi ; Roger, Lightfoot ; Hester, Lingsma ; Dirk, Loeckx ; Angels, Lozano ; Andrew, Maas IR ; Stephen, MacDonald ; Marc, Maegele ; Marek, Majdan ; Sebastian, Major ; Alex, Manara ; Geoffrey, Manley ; Didier, Martin ; Francisco, Martin Leon ; Costanza, Martino ; Armando, Maruenda ; Hugues, Marechal ; Alessandro, Masala ; Julia, Mattern ; Charles, McFadyen ; Catherine, McMahon ; Bela, Melegh ; David, Menon ; Tomas, Menovsky ; Cristina, Morganti-Kossmann ; Davide, Mulazzi ; Visakh, Muraleedharan ; Lynnette, Murray ; Holger, Muehlan ; Nandesh, Nair ; Ancuta, Negru ; David, Nelson ; Virginia, Newcombe ; Daan, Nieboer ; Quentin, Noirhomme ; Jozsef, Nyiradi ; Mauro, Oddo ; Annemarie, Oldenbeuving ; Matej, Oresic ; Fabrizio, Ortolano ; Aarno, Palotie ; Paul, Parizel M ; Adriana, Patruno ; Jean-Francois, Payen ; Natascha, Perera ; Vincent, Perlbarg ; Paolo, Persona ; PeulWilco, ; Anna, Piippo-Karjalainen ; Sebastien, Pili Floury ; Matti, Pirinen ; Horia, Ples ; Maria Antonia, Poca ; Suzanne, Polinder ; Inigo, Pomposo ; Jussi, Posti ; Louis, Puybasset ; Andreea, Radoi ; Arminas, Ragauskas ; Rahul, Raj ; Malinka, Rambadagalla ; Ruben, Real ; Veronika, Rehorcikova ; Jonathan, Rhodes ; Samuli, Ripatti ; Saulius, Rocka ; Cecilie, Roe ; Olav, Roise ; Gerwin, Roks ; Jonathan, Rosand ; Jeffrey, Rosenfeld ; Christina, Rosenlund ; Guy, Rosenthal ; Rolf, Rossaint ; Sandra, Rossi ; Daniel, Rueckert ; Martin, Rusnak ; Marco, Sacchi ; Barbara, Sahakian ; Juan, Sahuquillo ; Oliver, Sakowitz ; Francesca, Sala ; Renan, Sanchez-Porras ; Janos, Sandor ; Edgar, Santos ; Luminita, Sasu ; Davide, Savo ; Nadine, Schaeffer ; Inger, Schipper ; Barbara, Schloesser ; Silke, Schmidt ; Herbert, Schoechl ; Guus, Schoonman ; Frederik, Schou Rico ; Elisabeth, Schwendenwein ; Michael, Schoell ; Ozcan, Sir ; Toril, Skandsen ; Lidwien, Smakman ; Dirk, Smeets ; Peter, Smielewski ; Abayomi, Sorinola ; Emmanuel, Stamatakis ; Simon, Stanworth ; Nicole, Steinbuechel ; Ana, Stevanovic ; Robert, Stevens ; William, Stewart ; Ewout, Steyerberg W ; Nino, Stocchetti ; Nina, Sundstrom ; Anneliese, Synnot ; Fabio Silvio, Taccone ; Riikka, Takala ; Viktoria, Tamas ; Paivi, Tanskanen ; Steven, Taylor Mark ; Braden, Te Ao ; Olli, Tenovuo ; Ralph, Telgmann ; Guido, Teodorani ; Alice, Theadom ; Matt, Thomas ; Dick, Tibboel ; Christos, Tolias ; Luaba, Tshibanda Jean-Flory ; Tony, Trapani ; Maria, Tudora Cristina ; Peter, Vajkoczy ; Shirley, Vallance ; Egils, Valeinis ; Gregory, Van der Steen ; Mathieu, Van der Jagt ; Joukje, Van der Naalt ; Jeroen, van Dijck TJM ; Thomas, Van Essen A ; Wim, Van Hecke ; Caroline, van Heugten ; Dominique, Van Praag ; Thijs, Vande Vyvere ; Julia, Van Waesberghe ; Audrey, Vanhaudenhuyse ; Alessia, Vargiolu ; Emmanuel, Vega ; Kimberley, Velt ; Jan, Verheyden ; Paul, Vespa M ; Anne, Vik ; Rimantas, Vilcinis ; Giacinta, Vizzino ; Carmen, Vleggeert-Lankamp ; Victor, Volovici ; Daphne, Voormolen ; Peter, Vulekovic ; Zoltan, Vamos ; Derick, Wade ; Kevin, Wang KW ; Lei, Wang ; Lars, Wessels ; Eno, Wildschut ; Guy, Williams ; Lindsay, Wilson ; Maren, Winkler KL ; Stefan, Wolf ; Peter, Ylen ; Alexander, Younsi ; Menashe, Zaaroor ; Yang, Zhihui ; Agate, Ziverte ; Fabrizio, Zumbo

Keywords:

Science & Technology, Life Sciences & Biomedicine, Clinical Neurology, Surgery, Neurosciences & Neurology, Traumatic brain injury, Neurosurgery, Practice variation, Acute subdural hematoma, RANDOMIZED CONTROLLED-TRIALS, ACUTE SUBDURAL HEMATOMAS, SURGICAL-MANAGEMENT, GUIDELINES, MODERATE, OUTCOMES, SURGERY, Brain Injuries, Traumatic, Clinical Decision-Making, Decompressive Craniectomy, Europe, Humans, Monitoring, Physiologic, Neurosurgeons, Surveys and Questionnaires, Trauma Centers, CENTER-TBI Investigators and Participants, 1103 Clinical Sciences, 1109 Neurosciences, Neurology & Neurosurgery, 3202 Clinical sciences, 3209 Neurosciences

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.