Changes in the management of severe traumatic brain injury: 1991-1997

Abstract

Objective: To survey the management of head-injured patients in 1997 and to identify differences compared with a survey conducted in 1991.

Design: A two-page questionnaire was mailed to all neurosurgeons in North America certified by the American Board of Neurologic Surgeons, asking their views regarding the most appropriate acute care of patients with severe traumatic brain injury (TBI).

Setting: North American neurosurgical practices.

Patients: Not applicable.

Interventions: None.

Measurements and main results: Compared with a 1991 survey, there was a significant increase in the proportion of neurosurgeons who felt these patients should have intracranial pressure monitoring (28% vs. 83%) and a decrease in the proportion who used prophylactic hyperventilation therapy (83% vs. 36%) and steroids (64% vs. 19%). Ninety-seven percent of respondents felt that the cerebral perfusion pressure should be maintained at >70 mm Hg, and 44% indicated that patients with severe TBI should be treated at Level I trauma centers.

Conclusions: There have been significant changes in the acute management of patients with severe TBI since 1991. Current practices more closely reflect the recommendations of evidence-based guidelines.