Management of Australian Patients with Severe Traumatic Brain Injury: Are Potentially Harmful Treatments Still Used?

Dashiell Gantner, Peter Bragge, Simon Finfer, Belinda Gabbe, Dinesh Varma, Steve Webb, Sharon Waterson, Manoj Saxena, Parveta Rengarajoo, Michael C. Reade, Tom Coates, Piers Thomas, Jamie Cooper

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Clinical trials have shown that intravenous albumin and decompressive craniectomy to treat early refractory intracranial hypertension can cause harm in patients with severe traumatic brain injury (TBI). The extent to which these treatments remain in use is unknown. We conducted a multi-center retrospective cohort study of adult patients with severe TBI admitted to five neurotrauma centers across Australia between April 2013 and March 2015. Patients were identified from local trauma and intensive care unit (ICU) registries and followed until hospital discharge. Main outcome measures were the administration of intravenous albumin, and decompressive craniectomy for intracranial hypertension. Analyses were predominantly descriptive. There were 303 patients with severe TBI, of whom a minority received albumin (6.9%) or underwent early decompressive craniectomy for treatment of refractory intracranial hypertension complicating diffuse TBI (2.3%). The median (intequartile range [IQR]) age was 35 (24, 58), and most injuries were caused by road traffic accidents (57.4%) or falls (25.1%). Overall, 34.3% of patients died while in the hospital and the remainder were discharged to rehabilitation (44.6%), other health care facilities (4.6%), or home (16.5%). There were no patient characteristics significantly associated with use of albumin or craniectomy. Intravenous albumin and craniectomy for treatment of intracranial hypertension were used infrequently in Australian neurotrauma centers, indicating alignment between best available evidence and practice.

Original languageEnglish
Pages (from-to)2686-2693
Number of pages8
JournalJournal of Neurotrauma
Volume37
Issue number24
DOIs
Publication statusPublished - 15 Dec 2020

Keywords

  • albumin
  • decompressive craniectomy
  • implementation
  • translation
  • traumatic brain injury

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