Hostname: page-component-7479d7b7d-m9pkr Total loading time: 0 Render date: 2024-07-13T16:24:04.789Z Has data issue: false hasContentIssue false
  • English
  • Français

Severe Head Injury: Clinicians’ Awareness of the Literature

Published online by Cambridge University Press:  02 December 2014

Michael J Jacka ,
Amanda Roze Des Ordons  and
David Zygun
Michael J Jacka*
Affiliation:
Department of Anesthesiology, Division of Critical Care, University of Alberta, Edmonton
Amanda Roze Des Ordons
Affiliation:
Department of Anesthesiology, Division of Critical Care, University of Alberta, Edmonton
David Zygun
Affiliation:
Departments of Critical Care Medicine, Clinical Neurosciences and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
*
8th Floor CSB, WCM HSC, University of Alberta, Edmonton, Alberta, T6G 2B7, Canada.
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objectives:

1. To determine the awareness of the literature concerning therapeutic manoeuvres in severe closed head injury (CHI) among Canadian critical care clinicians and neurosurgeons, 2. To identify factors that affect utilization of these manoeuvres, and 3. To compare reported appropriateness and frequency of use with #1 and #2.

Methods:

The study design was a systematic scenario-based survey of all neurosurgeons and critical care physicians treating patients with severe CHI in Canada.

Results:

Fifty-nine of 99 neurosurgeons and 82 of 148 critical care physicians responded (57%). The majority of respondents were not able to identify the highest level of published evidence for most manoeuvres, except for the avoidance of corticosteroids (51%). The factor identified by most respondents as being most important in motivating use of any given manoeuvres was the level of published evidence (25%). Although reported appropriateness and frequency of use of most manoeuvres correlated well with each other, they did not correlate with awareness of evidence. In the case of corticosteroids, there was a strong correlation between non-use of steroids and awareness of evidence (R = - 0.30, p = 0.0003).

Conclusions:

Respondents to this survey of Canadian physicians treating patients with severe head injury reported published evidence as being the most significant factor affecting use of a therapy. However, most respondents did not correctly identify the highest published level of evidence for most therapies. This study has identified difficulty with research translation that may have clinical implications.

Résumé:

RÉSUMÉ:Objectifs:

1. Déterminer le niveau de connaissance de la littérature concernant les manoeuvres thérapeutiques dans le traumatisme crânien fermé sévère (TCF) chez les cliniciens et les neurochirurgiens canadiens qui dispensent des soins aux grands blessés ; 2. Identifier les facteurs qui influencent ces manoeuvres et 3. Comparer la pertinence et la fréquence de leur utilisation par ces intervenants.

Méthodes:

Il s’agit d’une enquête systématique basée sur des scénarios, qui s’adresse à tous les neurochirurgiens et les médecins qui travaillent dans une unité de soins intensifs et qui traitent des patients présentant un TCF au Canada.

Résultats:

Cinquante–neuf des 99 neurochirurgiens et 82 des 148 médecins travaillant dans un service de soins aux grands blessés ont répondu (57%). La majorité des répondants n’étaient pas capables d’identifier le niveau le plus élevé de preuves publiées pour la plupart des manoeuvres sauf en ce qui a trait à l’abstention d’administrer des corticostéroïdes (51%). Le facteur identifié par la plupart des répondants comme étant le plus important dans la décision d’utiliser telle ou telle manoeuvre était le niveau de preuve publié (25%). Bien que la pertinence et la fréquence d’utilisation de la plupart des manoeuvres étaient bien corrélées entre elles, elles n’étaient pas corrélées à la connaissance des preuves. Il existait une forte corrélation entre la non–utilisation des stéroïdes et la connaissance des preuves (r = –0,30 ; p = 0,0003).

Conclusions:

Les répondants à cette enquête chez les médecins canadiens qui traitent des patients atteints de traumatisme crânien sévère ont rapporté que les preuves publiées étaient le facteur le plus important pour déterminer l’utilisation d’un traitement. Cependant, la plupart des répondants n’ont pas identifié correctement le niveau de preuve le plus élevé publié pour la plupart des traitements. Cette étude a identifié la difficulté de transposer la recherche en pratique, ce qui peut avoir des implications cliniques.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 35 , Issue 4 , September 2008 , pp. 458 - 471
Copyright
Copyright © The Canadian Journal of Neurological 2008

References

1. Zygun, DA, Laupland, KB, Hader, WJ, Kortbeek, JB, Findlay, C, Doig, CJ, et al. Severe traumatic brain injury in a large Canadian health region. Can J Neurol Sci. 2005; 32(1): 87–92 Google Scholar
2. Jacka, MJ, Zygun, DA. Survey of management of severe head injury in Canada. Can J Neurol Sci. 2007; 34(3): 307–12.CrossRefGoogle ScholarPubMed
3. Sekula, RF Jr., Wilberger, JE. The management of traumatic brain injury: the development of guidelines and their influence. Clin Neurosurg. 2005; 52:306–10 Google Scholar
4. Guidelines for the management of severe traumatic brain injury. J Neurotrauma. 2000; 17(6/7): 450–553.Google Scholar
5.www.braintrauma.orgGoogle Scholar
6. Bulger, EM, Nathens, AB, Rivara, FP, Moore, M, MacKenzie, EJ, Jurkovich, GJ. Management of severe head injury: institutional variations in care and effect on outcome. Crit Care Med. 2002; 30(8): 1870–6.Google Scholar
7. Kerr, J, Smith, R, Gray, S, Beard, D, Robertson, CE. An audit of clinical practice in the management of head injured patients following the introduction of the Scottish Intercollegiate Guidelines Network (SIGN) recommendations. Emerg Med J. 2005; 22(12): 850–4.CrossRefGoogle ScholarPubMed
8. Roberts, I, Yates, D, Sandercock, P, Farrell, B, Wasserberg, J, Lomas, G, et al. Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury. Lancet. 2004; 364(9442): 1321–8.Google Scholar
9. Prabhakaran, P, Reddy, AT, Oakes, WJ, King, WD, Winkler, MK, Givens, TG. A pilot trial comparing cerebral perfusion pressure-targeted therapy to intracranial pressure-targeted therapy in children with severe traumatic brain injury. J Neurosurg. 2004; 100(5 Suppl Pediatrics): 454–9.Google Scholar
10. Rossi, S, Buzzi, F, Paparella, A, Mainini, P, Stocchetti, N. Complications and safety associated with ICP monitoring: a study of 542 patients. Acta Neurochirurgica. 1998; Supplement 71: 91–3.Google Scholar
11. Schierhout, G, Roberts, I. Mannitol for acute traumatic brain injury. Cochrane database of systematic reviews. 2003; (2): CD001049; PMID : 12804397.Google Scholar
12. Cooper, DJ, Myles, PS, McDermott, FT, Murray, LJ, Laidlaw, J, Cooper, G, et al. Prehospital hypertonic saline resuscitation of patients with hypotension and severe traumatic brain injury: a randomized controlled trial. JAMA. 2004; 291 (11): 1350–7.Google Scholar
13. Battison, C, Andrews, PJ, Graham, C, Petty, T. Randomized, controlled trial on the effect of a 20% mannitol solution and a 7.5% saline/6% dextran solution on increased intracranial pressure after brain injury. Crit Care Med. 2005; 33(1): 196–202.Google Scholar
14. Yanagawa, T, Bunn, F, Roberts, I, Wentz, R, Pierro, A. Nutritional support for head-injured patients. Cochrane Database of Systematic Reviews. 2002; (3):CD001530.Google Scholar
15. Schierhout, G, Roberts, I. Hyperventilation therapy for acute traumatic brain injury. Cochrane Database of Systematic Reviews. 2000; (2): CD000566.Google ScholarPubMed
16. Muizelaar, JP, Marmarou, A, Ward, JD, Kontos, HA, Choi, SC, Becker, DP, et al. Adverse effects of prolonged hyperventilation in patients with severe head injury: a randomized clinical trial. J Neurosurg. 1991;75(5): 731–9.Google Scholar
17. Marion, DW, Penrod, LE, Kelsey, SF, Obrist, WD, Kochanek, PM, Palmer, AM, et al. Treatment of traumatic brain injury with moderate hypothermia. N Engl J Med. 1997; 336(8): 540–6.CrossRefGoogle ScholarPubMed
18. Clifton, GL, Miller, ER, Choi, SC, Levin, HS, McCauley, S, Smith, KR Jr., et al. Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med. 2001; 344(8): 556–63.CrossRefGoogle ScholarPubMed
19.www.clinicaltrials.govGoogle Scholar
20. Temkin, NR, Dikmen, SS, Wilensky, AJ, Keihm, J, Chabal, S, Winn, HR. A randomized, double-blind study of phenytoin for the prevention of post-traumatic seizures. N Engl J Med. 1990; 323(8): 497–502.CrossRefGoogle ScholarPubMed
21. Karabinis, A, Mandragos, K, Stergiopoulos, S, Komnos, A, Soukup, J, Speelberg, B, et al. Safety and efficacy of analgesia-based sedation with remifentanil versus standard hypnotic-based regimens in intensive care unit patients with brain injuries: a randomised, controlled trial. Crit Care. 2004; 8(4): R268–80.Google Scholar
22. Pillai, SV, Kolluri, VR, Mohanty, A, Chandramouli, BA. Evaluation of nimodipine in the treatment of severe diffuse head injury: a double-blind placebo-controlled trial. Neurology India. 2003; 51(3): 361–3.Google Scholar
23. Mayer, SA, Kowalski, RG, Presciutti, M, Ostapkovich, ND, McGann, E, Fitzsimmons, BF, et al. Clinical trial of a novel surface cooling system for fever control in neurocritical care patients. Crit Care Med. 2004; 32(12): 2508–15.Google Scholar
24. Juul, N, Morris, GF, Marshall, SB, Marshall, LF. Neuromuscular blocking agents in neurointensive care. Acta Neurochirurgica. 2000; 76: 467–70.Google Scholar
25. Young, KD, Okada, PJ, Sokolove, PE, Palchak, MJ, Panacek, EA, Baren, JM, et al. A randomized, double-blinded, placebo-controlled trial of phenytoin for the prevention of early posttraumatic seizures in children with moderate to severe blunt head injury. Ann Emerg Med. 2004; 43(4): 435–46.Google Scholar
26. Gupta, AK, Hutchinson, PJ, Al-Rawi, P, Gupta, S, Swart, M, Kirkpatrick, PJ, et al. Measuring brain tissue oxygenation compared with jugular venous oxygen saturation for monitoring cerebral oxygenation after traumatic brain injury. Anesth Analg. 1999; 88(3): 549–53.Google Scholar
27. van den Berghe, G, Wouters, P, Weekers, F, Verwaest, C, Bruyninckx, F, Schetz, M, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001; 345(19): 1359–67.Google Scholar
28. Alderson, P, Gadkary, C, Signorini, DF. Therapeutic hypothermia for head injury. Cochrane Database of Systematic Reviews. 2004; (4): CD001048.Google Scholar