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Hawryluk GWJ, Ghajar J. Evolution and Impact of the Brain Trauma Foundation Guidelines. Neurosurgery 2021; 89:1148-1156. [PMID: 34634822 DOI: 10.1093/neuros/nyab357] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/31/2021] [Indexed: 11/13/2022] Open
Abstract
The Brain Trauma Foundation (BTF) Guidelines for the Management of Severe Head Injury were the first clinical practice guidelines published by any surgical specialty. These guidelines have earned a reputation for rigor and have been widely adopted around the world. Implementation of these guidelines has been associated with a 50% reduction in mortality and reduced costs of patient care. Over their 25-yr history the traumatic brain injury (TBI) guidelines have been expanded, refined, and made increasingly more rigorous in conjunction with new clinical evidence and evolving methodologic standards. Here, we discuss the history and accomplishments of BTF guidelines for TBI as well as their limitations. We also discuss planned changes to future TBI guidelines intended to increase their utility and positive impact in an evolving medical landscape. Perhaps the greatest limitation of TBI guidelines now is the lack of high-quality clinical research as well as novel diagnostics and treatments with which to generate substantially new recommendations.
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Affiliation(s)
- Gregory W J Hawryluk
- Section of Neurosurgery, GB1 - Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jamshid Ghajar
- Department of Neurosurgery and the Brain Performance Center, Stanford University, Palo Alto, California, USA
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Huijben JA, Wiegers EJA, de Keizer NF, Maas AIR, Menon D, Ercole A, Citerio G, Lecky F, Wilson L, Cnossen MC, Polinder S, Steyerberg EW, van der Jagt M, Lingsma HF. Development of a quality indicator set to measure and improve quality of ICU care for patients with traumatic brain injury. Crit Care 2019; 23:95. [PMID: 30902117 PMCID: PMC6431034 DOI: 10.1186/s13054-019-2377-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 02/26/2019] [Indexed: 11/18/2022] Open
Abstract
Background We aimed to develop a set of quality indicators for patients with traumatic brain injury (TBI) in intensive care units (ICUs) across Europe and to explore barriers and facilitators for implementation of these quality indicators. Methods A preliminary list of 66 quality indicators was developed, based on current guidelines, existing practice variation, and clinical expertise in TBI management at the ICU. Eight TBI experts of the Advisory Committee preselected the quality indicators during a first Delphi round. A larger Europe-wide expert panel was recruited for the next two Delphi rounds. Quality indicator definitions were evaluated on four criteria: validity (better performance on the indicator reflects better processes of care and leads to better patient outcome), feasibility (data are available or easy to obtain), discriminability (variability in clinical practice), and actionability (professionals can act based on the indicator). Experts scored indicators on a 5-point Likert scale delivered by an electronic survey tool. Results The expert panel consisted of 50 experts from 18 countries across Europe, mostly intensivists (N = 24, 48%) and neurosurgeons (N = 7, 14%). Experts agreed on a final set of 42 indicators to assess quality of ICU care: 17 structure indicators, 16 process indicators, and 9 outcome indicators. Experts are motivated to implement this finally proposed set (N = 49, 98%) and indicated routine measurement in registries (N = 41, 82%), benchmarking (N = 42, 84%), and quality improvement programs (N = 41, 82%) as future steps. Administrative burden was indicated as the most important barrier for implementation of the indicator set (N = 48, 98%). Conclusions This Delphi consensus study gives insight in which quality indicators have the potential to improve quality of TBI care at European ICUs. The proposed quality indicator set is recommended to be used across Europe for registry purposes to gain insight in current ICU practices and outcomes of patients with TBI. This indicator set may become an important tool to support benchmarking and quality improvement programs for patients with TBI in the future. Electronic supplementary material The online version of this article (10.1186/s13054-019-2377-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jilske A Huijben
- Department of Public Health, Center for Medical Decision Making, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Eveline J A Wiegers
- Department of Public Health, Center for Medical Decision Making, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nicolette F de Keizer
- Department of Medical Informatics, Amsterdam Public Health research institute, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Andrew I R Maas
- Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - David Menon
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Ari Ercole
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Giuseppe Citerio
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.,Neuro-Intensive Care, Department of Emergency and Intensive Care, San Gerardo Hospital, ASST, Monza, Italy
| | - Fiona Lecky
- Centre for Urgent and Emergency Care Research, School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Lindsay Wilson
- Division of Psychology, University of Stirling, Stirling, UK
| | - Maryse C Cnossen
- Department of Public Health, Center for Medical Decision Making, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Suzanne Polinder
- Department of Public Health, Center for Medical Decision Making, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ewout W Steyerberg
- Department of Public Health, Center for Medical Decision Making, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Mathieu van der Jagt
- Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Hester F Lingsma
- Department of Public Health, Center for Medical Decision Making, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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