학술논문
Early management of isolated severe traumatic brain injury patients in a hospital without neurosurgical capabilities: a consensus and clinical recommendations of the World Society of Emergency Surgery (WSES).
Document Type
Article
Author
Picetti, Edoardo; Catena, Fausto; Abu-Zidan, Fikri; Ansaloni, Luca; Armonda, Rocco A.; Bala, Miklosh; Balogh, Zsolt J.; Bertuccio, Alessandro; Biffl, Walt L.; Bouzat, Pierre; Buki, Andras; Cerasti, Davide; Chesnut, Randall M.; Citerio, Giuseppe; Coccolini, Federico; Coimbra, Raul; Coniglio, Carlo; Fainardi, Enrico; Gupta, Deepak; Gurney, Jennifer M.
Source
Subject
*Brain injury treatment
*Consensus (Social sciences)
*Intensive care units
*Hospital emergency services
*Health services accessibility
*Anesthesia
*Neurosurgery
*Time
*Health care teams
*Critical care medicine
*Physicians
*Computed tomography
*Resource-limited settings
*Delphi method
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Language
ISSN
1749-7922
Abstract
Background: Severe traumatic brain-injured (TBI) patients should be primarily admitted to a hub trauma center (hospital with neurosurgical capabilities) to allow immediate delivery of appropriate care in a specialized environment. Sometimes, severe TBI patients are admitted to a spoke hospital (hospital without neurosurgical capabilities), and scarce data are available regarding the optimal management of severe isolated TBI patients who do not have immediate access to neurosurgical care. Methods: A multidisciplinary consensus panel composed of 41 physicians selected for their established clinical and scientific expertise in the acute management of TBI patients with different specializations (anesthesia/intensive care, neurocritical care, acute care surgery, neurosurgery and neuroradiology) was established. The consensus was endorsed by the World Society of Emergency Surgery, and a modified Delphi approach was adopted. Results: A total of 28 statements were proposed and discussed. Consensus was reached on 22 strong recommendations and 3 weak recommendations. In three cases, where consensus was not reached, no recommendation was provided. Conclusions: This consensus provides practical recommendations to support clinician's decision making in the management of isolated severe TBI patients in centers without neurosurgical capabilities and during transfer to a hub center. [ABSTRACT FROM AUTHOR]