Adherence in Evidence-Based Neurotrauma Guidelines: A Worldwide Survey.

Autor: Beraldo RF; Department of Neurosurgery, Catholic Pontificate University of Paraná, Curitiba, Paraná, Brazil., Pereira MC; MD. ENT. - Director of Cadaveric Studies and Skull Base Lab. Department of Otolaryngology-Head and Neck Surgery. Albany Medical Centre, Albany, New York, United States., Liebl B; Medical Student. Hospital de Clínicas, Federal University of Paraná - UFPR, Curitiba, Paraná, Brazil., Garg K; Additional Professor, Department of Neurosurgery, All India Institute of Medical Sciences, New Dehi, India., Deora H; Associate Professor, Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, India., Harland TA; Department of Neurosurgery, Albany Medical College, Albany, NY, United States., Pahwa B; Medical Student, University College of Medical Sciences and GTB Hospital - New Delhi, Delhi, India., de Souza Araújo PV; Department of Neurosurgery, Catholic Pontificate University of Paraná, Curitiba, Paraná, Brazil., Pereira Silvestre PA; Additional Professor, Department of Neurosurgery, All India Institute of Medical Sciences, New Dehi, India., Henrique Weiler Ceccato G; Department of Neurosurgery, Mackenzie Evangelical University Hospital, Curitiba, Paraná, Brazil., Piedade GS; Department of Neurosurgery, Dusseldorf University Hospital, Heinrich Heine University Dusseldorf, Düsseldorf, Germany; Department of Pediatric Neurosurgery, Nicklaus Children's Hospital, Miami, FL, United States., Demartini Z Jr; Department of Neurosurgery. Hospital de Clínicas, Federal University of Paraná - UFPR, Curitiba, Paraná, Brazil., Chaurasia B; Department of Neurosurgery, Neurosurgery Clinic, Birgunj, Nepal. Electronic address: trozexa@gmail.com.
Jazyk: angličtina
Zdroj: World neurosurgery [World Neurosurg] 2024 Dec 24, pp. 123608. Date of Electronic Publication: 2024 Dec 24.
DOI: 10.1016/j.wneu.2024.123608
Abstrakt: Background: Traumatic brain injury (TBI) management guidelines vary across regions and there is limited research on real-world adherence to these guidelines. We conducted a global survey to assess the adherence of neurosurgeons to TBI guidelines and evidence-based medicine (EBM).
Method: A 24-item survey was created using Google Forms, covering demographic information, neurotrauma training, basic knowledge of EBM, surgical and in-hospital management.
Results: Responses were collected from 233 neurosurgeons across 53 different countries. Approximately 45% of respondents reported not staying up to date with Brain Trauma Foundation (BTF) guidelines, and 48% indicated a preference for relying on their own experience over EBM guidelines. Neurosurgeons from Asia and Africa were more likely to rely on personal experience, while those from Europe, North/Central and South America leaned towards EBM (p=0.021). Additionally, 56% of respondents reported that their neurotrauma management at least sometimes diverged from recommended guidelines. Specifically, 58% never or rarely managed epidural hematoma of 30cm³ conservatively, and 45% sometimes, often, or always treated subdural hematomas conservatively, even when EBM recommended surgery. Moreover, 24% at least sometimes managed patients conservatively despite a Glasgow Coma Scale (GCS) score of less than 9 or a decrease of two or more points. In cerebellar hematomas, 46% sometimes opted for external ventricular drainage alone.
Conclusion: Neurosurgeons from Europe, North/Central and South America tend to follow EBM guidelines more closely, while those from Asia and Africa often favor individual decision-making approaches.
(Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
Externí odkaz: