Variation in Guideline Implementation and Adherence Regarding Severe Traumatic Brain Injury Treatment: A CENTER-TBI Survey Study in Europe
Variation in Guideline Implementation and Adherence Regarding Severe Traumatic Brain Injury Treatment: A CENTER-TBI Survey Study in Europe
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DOI：
10.1016/j.wneu.2019.01.116
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发表时间：
2019-05-01
影响因子：
2
通讯作者：
Lingsma, Hester F.
中科院分区：
文献类型：
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作者：
Volovici, Victor;Ercole, Ari;Lingsma, Hester F.
目的：指导方针可以减少实践差异，优化患者护理。方法：作为一项前瞻性、观察性、多中心欧洲队列研究的一部分，来自20个国家的68个中心的参与者被要求完成关于他们对重型脑损伤的处理的72个项目的问卷调查。结果：65个中心完成了问卷调查。其中，49人(75%)报告使用了脑创伤基金会指南或相关机构方案进行医疗管理，11人(17%)没有使用指南，5人(8%)使用了其他指南。在54个报告使用任何指南的中心中，41个(75%)依赖书面指南。54个中心中有4个(7%)报告没有正式执行工作。21个中心(38%)报告了在日常临床查房期间对指南的结构性关注。最常报告的不遵守指南的原因是“每个患者都是独一无二的”，以及颅外损伤的存在，这两个中心都有和没有报告使用指南的情况。结论：在欧洲的神经创伤中心，指南的使用和实施存在很大的差异。需要进一步研究，以加强作为准则基础的证据，并克服执行障碍。
OBJECTIVE: Guidelines may reduce practice variation and optimize patient care. We aimed to study differences in guideline use in the management of traumatic brain injury (TBI) patients and analyze reasons for guideline nonadherence.METHODS: As part of a prospective, observational, multicenter European cohort study, participants from 68 centers in 20 countries were asked to complete 72-item questionnaires regarding their management of severe TBI. Six questions with multiple sub-questions focused on guideline use and implementation.RESULTS: Questionnaires were completed by 65 centers. Of these, 49 (75%) reported use of the Brain Trauma Foundation guidelines for the medical management of TBI or related institutional protocols, 11 (17%) used no guidelines, and 5 used other guidelines (8%). Of 54 centers reporting use of any guidelines, 41 (75%) relied on written guidelines. Four centers of the 54 (7%) reported no formal implementation efforts. Structural attention to the guidelines during daily clinical rounds was reported by 21 centers (38%). The most often reported reasons for nonadherence were "every patient is unique" and the presence of extracranial injuries, both for centers that did and did not report the use of guidelines.CONCLUSIONS: There is substantial variability in the use and implementation of guidelines in neurotrauma centers in Europe. Further research is needed to strengthen the evidence underlying guidelines and to overcome implementation barriers.