Abstract
PurposeClinical guidelines have been developed to standardize the management of mild traumatic brain injury (mTBI) in the emergency room, in particular the indication of brain CT scan and the use of blood biomarkers. The objective of this study was to determine the degree of adherence to guidelines in the management of these patients across four countries of Southern Europe.MethodsAn electronic survey including structural and general management of mTBI patients and six clinical vignettes was conducted. In-charge physicians from France, Spain, Greece and Portugal were contacted by telephone and email. Differences among countries were searched using an unconditional approach test on contingency tables.ResultsOne hundred and eighty eight physicians from 131 Hospitals (78 Spain, 36 France, 12 Greece and 5 Portugal) completed the questionnaire. There were differences regarding the in-charge specialist across these countries. There was variability in the use of guidelines and their adherence. Spain was the country with the least guideline adherence. There was a global agreement in ordering a brain CT for patients receiving anticoagulation or platelet inhibitors, and for patients with seizures, altered consciousness, neurological deficit, clinical signs of skull fracture or signs of facial fracture. Aging was not an indication for CT in French centres. Loss of consciousness and posttraumatic amnesia were considered as indications for CT more frequently in Spain than in France. These findings were in line with the data from the 6 clinical vignettes. The estimated use of CT reached around 50% of mTBI cases. The use of S100B is restricted to five French centres.ConclusionsThere were large variations in the guideline adherence, especially in the situations considered to order brain CT after mTBI.
Highlights
Traumatic brain injury (TBI) is a common cause of admission to emergency departments
Most TBI patients admitted to EDs are classified as mild TBI, defined by presenting with a Glasgow Coma Score (GCS) between 13 and 15 [1,2,3]
The goal of this study was to investigate how mild TBI (mTBI) is being managed in different Southern European countries with regards to which speciality is responsible for the management of mTBI patients, guideline use and adherence, indications for cranial CT and use of S100B in the management protocols in these countries
Summary
Traumatic brain injury (TBI) is a common cause of admission to emergency departments. Several prediction rules and guidelines have been developed to estimate the risk of presenting an intracranial lesion, and be in risk of further deterioration Some of these rules have gained international recognition, such as Canadian CT head rule [7], the New Orleans criteria [8], or the National Institute of Health and Care Excellence (NICE) guidelines [9]. These guidelines and others designed locally [10], use different clinical and examination factors to determine the need of performing cranial CT based on the risk of presenting intracranial lesions. These guidelines formulated indications for a cranial CT and how management of mTBI should be carried out in a safe and effective manner
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