The Roles of Protocols and Protocolization in Improving Outcome From Severe Traumatic Brain Injury.

Autor:	Chesnut RM; Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.; Department of Orthopaedic Surgery, University of Washington, Seattle, Washington, USA.; School of Global Health, University of Washington, Seattle, Washington, USA.; Harborview Medical Center, University of Washington, Seattle, Washington, USA., Temkin N; Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.; Department of Biostatistics, University of Washington, Seattle, Washington, USA., Videtta W; Terapia Intensiva, Hospital Nacional Professor Alejandro Posadas, Buenos Aires, Argentina., Lujan S; Hospital Emergencia, Dr Clemente Alvarez, Rosario, Argentina.; Centro de Informatica e Investigacion Clinica, Rosario, Argentina., Petroni G; School of Global Health, University of Washington, Seattle, Washington, USA., Pridgeon J; Department of Neurological Surgery, University of Washington, Seattle, Washington, USA., Dikmen S; Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA., Chaddock K; Department of Neurological Surgery, University of Washington, Seattle, Washington, USA., Hendrix T; San Diego, California, USA., Barber J; Department of Neurological Surgery, University of Washington, Seattle, Washington, USA., Machamer J; Department of Neurological Surgery, University of Washington, Seattle, Washington, USA., Guadagnoli N; Hospital Emergencia, Dr Clemente Alvarez, Rosario, Argentina.; Centro de Informatica e Investigacion Clinica, Rosario, Argentina., Hendrickson P; Department of Neurological Surgery, University of Washington, Seattle, Washington, USA., Alanis V; Terapia Intensiva, Hospital San Juan de Dios, Santa Cruz de la Sierra, Bolivia., La Fuente G; Terapia Intensiva, Hospital Japones, Santa Cruz de la Sierra, Bolivia., Lavadenz A; Terapia Intensiva, Hospital Videma, Cochabamba, Bolivia., Merida R; Terapia Intensiva, Hospital San Juan de Dios, Tarija, Bolivia., Sandi Lora F; Terapia Intensiva, Hospital Obrero No 1, La Paz, Bolivia., Romero R; Terapia Intensiva, Fundacion Clinica Campbell, Barranquilla, Colombia., Pinillos O; Terapia Intensiva, Clinica Universitaria Rafael Uribe, Cali, Colombia., Urbina Z; Terapia Intensiva, Hospital Erasmo Meoz ICU No 1, Cucuta, Colombia., Figueroa J; Terapia Intensiva, Hospital Erasmo Meoz ICU No 2, Cucuta, Colombia., Ochoa M; Terapia Intensiva, Hospital José Carrasco Artega, Cuenca, Ecuador., Davila R; Terapia Intensiva, Hospital Luis Razetti, Barinas, Venezuela., Mora J; Terapia Intensiva, Hospital Luis Razetti, Barcelona, Venezuela., Bustamante L; Terapia Intensiva, Delicia Conception Hospital Masvernat, Concordia, Entre Ríos, Argentina., Perez C; Terapia Intensiva, Hospital Justo José de Urquiza, Concepción del Uruguay, Entre Ríos, Argentina., Leiva J; Terapia Intensiva, Hospital Córdoba, Córdoba, Argentina., Carricondo C; Terapia Intensiva, Hospital Central, Mendoza, Argentina., Mazzola AM; Terapia Intensiva, Hospital San Felipe, Buenos Aires, Argentina., Guerra J; Terapia Intensiva, Hospital COSSMIL Militar, Louisiana Paz, Bolivia.
Jazyk:	angličtina
Zdroj:	Neurosurgery [Neurosurgery] 2023 Dec 05. Date of Electronic Publication: 2023 Dec 05.
DOI:	10.1227/neu.0000000000002777
Abstrakt:	Background and Objectives: Our Phase-I parallel-cohort study suggested that managing severe traumatic brain injury (sTBI) in the absence of intracranial pressure (ICP) monitoring using an ad hoc Imaging and Clinical Examination (ICE) treatment protocol was associated with superior outcome vs nonprotocolized management but could not differentiate the influence of protocolization from that of the specific protocol. Phase II investigates whether adopting the Consensus REVised Imaging and Clinical Examination (CREVICE) protocol improved outcome directly or indirectly via protocolization. Methods: We performed a Phase-II sequential parallel-cohort study examining adoption of the CREVICE protocol from no protocol vs a previous protocol in patients with sTBI older than 13 years presenting ≤24 hours after injury. Primary outcome was prespecified 6-month recovery. The study was done mostly at public South American centers managing sTBI without ICP monitoring. Fourteen Phase-I nonprotocol centers and 5 Phase-I protocol centers adopted CREVICE. Data were analyzed using generalized estimating equation regression adjusting for demographic imbalances. Results: A total of 501 patients (86% male, mean age 35.4 years) enrolled; 81% had 6 months of follow-up. Adopting CREVICE from no protocol was associated with significantly superior results for overall 6-month extended Glasgow Outcome Score (GOSE) (protocol effect = 0.53 [0.11, 0.95], P = .013), mortality (36% vs 21%, HR = 0.59 [0.46, 0.76], P < .001), and orientation (Galveston Orientation and Amnesia Test discharge protocol effect = 10.9 [6.0, 15.8], P < .001, 6-month protocol effect = 11.4 [4.1, 18.6], P < .005). Adopting CREVICE from ICE was associated with significant benefits to GOSE (protocol effect = 0.51 [0.04, 0.98], P = .033), 6-month mortality (25% vs 18%, HR = 0.55 [0.39, 0.77], P < .001), and orientation (Galveston Orientation and Amnesia Test 6-month protocol effect = 9.2 [3.6, 14.7], P = .004). Comparing both groups using CREVICE, those who had used ICE previously had significantly better GOSE (protocol effect = 1.15 [0.09, 2.20], P = .033). Conclusion: Centers managing adult sTBI without ICP monitoring should strongly consider protocolization through adopting/adapting the CREVICE protocol. Protocolization is indirectly supported at sTBI centers regardless of resource availability. (Copyright © Congress of Neurological Surgeons 2023. All rights reserved.)
Databáze:	MEDLINE
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