Author(s): Hesdorffer DC, Ghajar J, Iacono L
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Abstract BACKGROUND: In 1995, evidence-based guidelines for the management of severe traumatic brain injury (TBI) were published and disseminated. Information regarding their implementation is limited. METHODS: During 1999 to 2000, we contacted all designated U.S. trauma centers caring for adults with severe TBI to determine the degree of guideline compliance and to identify predictors. RESULTS: Of 924 centers identified, 828 participated (90\%). Four hundred thirty-three with intensive care units caring for severe TBI were surveyed. Three hundred ninety-five centers transferring patients were excluded. Full guideline compliance was rare (n = 68 [16\%]). In multivariate analyses, treatment protocols (odds ratio [OR], 3.6; 95\% confidence interval [CI], 1.9-6.6), neurosurgery residency program (OR, 5.0; 95\% CI, 2.6-9.8), and state (OR, 2.7; 95\% CI, 0.62-12) or American College of Surgeons (OR, 5.1; 95\% CI, 1.1-23) designation increased the likelihood of full compliance versus noncompliance. CONCLUSION: Although evidence-based guidelines were published and disseminated in 1995, implementation is infrequent. Focus must turn to changing physician practice and transport decisions to provide guideline-compliant care and improve patient outcome.
This article was published in J Trauma
and referenced in Journal of Nursing & Care