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

Ryan Hirschi; Casey Rommel; Joshua Letsinger; Raminder Nirula; Gregory W J Hawryluk

doi:10.1016/j.wneu.2018.04.215

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

World Neurosurg. 2018 Aug:116:e399-e405. doi: 10.1016/j.wneu.2018.04.215. Epub 2018 May 9.

Authors

Ryan Hirschi¹, Casey Rommel², Joshua Letsinger³, Raminder Nirula⁴, Gregory W J Hawryluk⁵

Affiliations

¹ School of Medicine, University of Utah, Salt Lake City, Utah, USA.
² Department of Biomedical Informatics, School of Medicine, University of Utah, Salt Lake City, Utah, USA.
³ Department of Neurological Surgery, University of Utah, Salt Lake City, Utah, USA.
⁴ Department of Surgery, University of Utah, Salt Lake City, Utah, USA.
⁵ Department of Neurological Surgery, University of Utah, Salt Lake City, Utah, USA. Electronic address: gregory.hawryluk@hsc.utah.edu.

PMID: 29751187
DOI: 10.1016/j.wneu.2018.04.215

Abstract

Background: Brain Trauma Foundation (BTF) guidelines reflect evidence-based best practices in management of traumatic brain injury. The aim of this study was to examine self-reported physician compliance and predictors of compliance related to BTF guidelines.

Methods: We conducted an international, multidisciplinary survey examining self-reported adherence to BTF guidelines and multiple factors potentially affecting adherence. We also surveyed intracranial pressure monitoring practices.

Results: Of 154 physician respondents, 15.9% reported their institutions "always" follow BTF guidelines and 72.2% reported that they follow them "most of the time." Personal volume of traumatic brain injury cases and years in practice were not significantly related to adherence. Reported adherence varied significantly in association with respondent's institutional trauma level (P = 0.0010): 17.3% of practitioners at level I, 13.0% at level II, and 0% at level III trauma centers reported "always" following guidelines. Reported adherence to guidelines also varied significantly in association with provider specialty (P = 0.015) and institutional volume of severe traumatic brain injury cases (P = 0.008). Regarding intracranial pressure monitoring practices, 52% of respondents used external ventricular drains, 21% used intraparenchymal monitors, and 27% had no preference (P < 0.001). Of respondents not routinely using external ventricular drains, 36% claimed to "always" follow guidelines. There was no apparent association between type of intracranial pressure monitoring used and reported guideline adherence.

Conclusions: Few respondents reported their institutions "always" follow BTF guidelines. General surgeons and providers at high-volume level I trauma centers were more likely to comply with guidelines. Differences in survey responses based on provider and institutional characteristics may help target educational efforts.

Keywords: Compliance; Guidelines; Intracranial Pressure Monitor; Survey; Traumatic brain injury.

MeSH terms

Brain Injuries, Traumatic / diagnosis
Brain Injuries, Traumatic / epidemiology
Brain Injuries, Traumatic / therapy*
Female
Foundations / standards*
Guideline Adherence / standards*
Humans
Internationality*
Intracranial Pressure / physiology
Male
Physicians / standards
Practice Guidelines as Topic / standards*
Surveys and Questionnaires*