TY - JOUR
T1 - Decompressive craniectomy practice following traumatic brain injury in comparison with randomized trials
T2 - harmonized, multi-center cohort studies in Europe, the United Kingdom, and Australia
AU - Gantner, Dashiell
AU - Wiegers, Eveline
AU - Bragge, Peter
AU - Finfer, Simon
AU - Delaney, Anthony
AU - Van Essen, Thomas
AU - Peul, Wilco
AU - Maas, Andrew I.R.
AU - Jamie Cooper, D.
AU - the CENTER-TBI investigators and participants
AU - Brooker, Joanne
AU - Cameron, Peter Alistair
AU - Rosenfeld, Jeffrey V.
N1 - Funding Information:
This research was funded by the European Commission 7th Framework program (602150), the Australian National Health and Medical Research Council (NHMRC 1074181) and the Victorian Transport Accident Commission (ISCRR N-14-129). Additional support for CENTER-TBI was provided by the Hannelore Kohl Stuftung (Germany), OneMind (USA), Integra LifeSciences Corporation (USA) and NeuroTrauma Sciences (USA). The funders had no role in the collection, analysis, and interpretation of data, nor in the writing of the report or in publication decisions. The authors had full access to study data and the senior authors had final responsibility for the decision to publish.
Publisher Copyright:
© 2022, Mary Ann Liebert, Inc., publishers.
PY - 2022
Y1 - 2022
N2 - High quality evidence shows decompressive craniectomy (DC) following traumatic brain injury (TBI) may improve survival but increase the number of severely disabled survivors. Contemporary international practice is unknown. We sought to describe international use of DC, and the alignment with evidence and clinical practice guidelines, by analyzing the harmonized Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) and Australia-Europe NeuroTrauma Effectiveness Research in Traumatic Brain Injury (OzENTER-TBI) core study datasets, which include patients admitted to intensive care units (ICUs) in Europe, the United Kingdom, and Australia between 2015 and 2017. Outcomes of interest were treatment with DC relative to clinical trial evidence and the Brain Trauma Foundation guidelines. Of 2336 people admitted to ICUs following TBI, DC was performed in 320 (13.7%): in 64/1422 (4.5%) patients with diffuse TBI and 195/640 (30.5%) patients with traumatic mass lesions. Secondary DC (for treatment of intracranial hypertension) was used infrequently in patients who met enrollment criteria of the two randomized clinical trials informing the guidelines-specifically, in 11/124 (8.9%) of those matching Decompressive Craniectomy in Diffuse Traumatic Brain Injury trial (DECRA) enrollment, and in 30/224 (13.4%) of those matching Randomised Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of Intracranial Pressure (RESCUEicp). Of patients who underwent DC, 258/320 (80.6%) were ineligible for either trial: 149/320 (46.6%) underwent primary DC, 62/320 (19.4%) were outside the trials' age criteria, and 126/320 (39.4%) did not develop intracranial hypertension refractory to non-operative therapies prior to DC. Secondary DC was used infrequently in patients in whom it had been shown to increase survival with severe disability, indicating alignment between contemporaneous evidence and practice. However, most patients who underwent DC were ineligible for the key trials; whether they benefited from DC remains unknown.
AB - High quality evidence shows decompressive craniectomy (DC) following traumatic brain injury (TBI) may improve survival but increase the number of severely disabled survivors. Contemporary international practice is unknown. We sought to describe international use of DC, and the alignment with evidence and clinical practice guidelines, by analyzing the harmonized Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) and Australia-Europe NeuroTrauma Effectiveness Research in Traumatic Brain Injury (OzENTER-TBI) core study datasets, which include patients admitted to intensive care units (ICUs) in Europe, the United Kingdom, and Australia between 2015 and 2017. Outcomes of interest were treatment with DC relative to clinical trial evidence and the Brain Trauma Foundation guidelines. Of 2336 people admitted to ICUs following TBI, DC was performed in 320 (13.7%): in 64/1422 (4.5%) patients with diffuse TBI and 195/640 (30.5%) patients with traumatic mass lesions. Secondary DC (for treatment of intracranial hypertension) was used infrequently in patients who met enrollment criteria of the two randomized clinical trials informing the guidelines-specifically, in 11/124 (8.9%) of those matching Decompressive Craniectomy in Diffuse Traumatic Brain Injury trial (DECRA) enrollment, and in 30/224 (13.4%) of those matching Randomised Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of Intracranial Pressure (RESCUEicp). Of patients who underwent DC, 258/320 (80.6%) were ineligible for either trial: 149/320 (46.6%) underwent primary DC, 62/320 (19.4%) were outside the trials' age criteria, and 126/320 (39.4%) did not develop intracranial hypertension refractory to non-operative therapies prior to DC. Secondary DC was used infrequently in patients in whom it had been shown to increase survival with severe disability, indicating alignment between contemporaneous evidence and practice. However, most patients who underwent DC were ineligible for the key trials; whether they benefited from DC remains unknown.
KW - Decompressive craniectomy
KW - Implementation science
KW - Translation
KW - Traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=85131696812&partnerID=8YFLogxK
U2 - 10.1089/neu.2021.0312
DO - 10.1089/neu.2021.0312
M3 - Article
C2 - 35243877
AN - SCOPUS:85131696812
SN - 0897-7151
VL - 39
SP - 860
EP - 869
JO - Journal of Neurotrauma
JF - Journal of Neurotrauma
IS - 11-12
ER -