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Early management of isolated severe traumatic brain injury patients in a hospital without neurosurgical capabilities: a consensus and clinical recommendations of the World Society of Emergency Surgery (WSES)

The University of Western Australia
Picetti, Edoardo ; Catena, Fausto ; Abu-Zidan, Fikri ; Ansaloni, Luca ; Armonda, Rocco A. ; Bala, Miklosh ; Balogh, Zsolt J. ; Bertuccio, Alessandro ; Biffl, Walt L. ; Bouzat, Pierre ; Buki, Andras ; Cerasti, Davide ; Chesnut, Randall M. ; Citerio, Giuseppe ; Coccolini, Federico ; Coimbra, Raul ; Coniglio, Carlo ; Fainardi, Enrico ; Gupta, Deepak ; Gurney, Jennifer M. ; Hawrylux, Gregory W. J. ; Helbok, Raimund ; Hutchinson, Peter J. A. ; Iaccarino, Corrado ; Kolias, Angelos ; Maier, Ronald W. ; Martin, Matthew J. ; Meyfroidt, Geert ; Okonkwo, David O. ; Rasulo, Frank ; Rizoli, Sandro ; Rubiano, Andres ; Sahuquillo, Juan ; Sams, Valerie G. ; Servadei, Franco ; Sharma, Deepak ; Shutter, Lori ; Stahel, Philip F. ; Taccone, Fabio S. ; Udy, Andrew ; Zoerle, Tommaso ; Agnoletti, Vanni ; Bravi, Francesca ; De Simone, Belinda ; Kluger, Yoram ; Martino, Costanza ; Moore, Ernest E. ; Sartelli, Massimo ; Weber, Dieter ; Robba, Chiara
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ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Adc&rfr_id=info%3Asid%2FANDS&rft_id=info:doi10.6084/m9.figshare.c.6579520&rft.title=Early management of isolated severe traumatic brain injury patients in a hospital without neurosurgical capabilities: a consensus and clinical recommendations of the World Society of Emergency Surgery (WSES)&rft.identifier=10.6084/m9.figshare.c.6579520&rft.publisher=Figshare&rft.description=Abstract Background Severe traumatic brain-injured (TBI) patients should be primarily admitted to a hub trauma center (hospital with neurosurgical capabilities) to allow immediate delivery of appropriate care in a specialized environment. Sometimes, severe TBI patients are admitted to a spoke hospital (hospital without neurosurgical capabilities), and scarce data are available regarding the optimal management of severe isolated TBI patients who do not have immediate access to neurosurgical care. Methods A multidisciplinary consensus panel composed of 41 physicians selected for their established clinical and scientific expertise in the acute management of TBI patients with different specializations (anesthesia/intensive care, neurocritical care, acute care surgery, neurosurgery and neuroradiology) was established. The consensus was endorsed by the World Society of Emergency Surgery, and a modified Delphi approach was adopted. Results A total of 28 statements were proposed and discussed. Consensus was reached on 22 strong recommendations and 3 weak recommendations. In three cases, where consensus was not reached, no recommendation was provided. Conclusions This consensus provides practical recommendations to support clinician’s decision making in the management of isolated severe TBI patients in centers without neurosurgical capabilities and during transfer to a hub center.&rft.creator=Picetti, Edoardo &rft.creator=Catena, Fausto &rft.creator=Abu-Zidan, Fikri &rft.creator=Ansaloni, Luca &rft.creator=Armonda, Rocco A. &rft.creator=Bala, Miklosh &rft.creator=Balogh, Zsolt J. &rft.creator=Bertuccio, Alessandro &rft.creator=Biffl, Walt L. &rft.creator=Bouzat, Pierre &rft.creator=Buki, Andras &rft.creator=Cerasti, Davide &rft.creator=Chesnut, Randall M. &rft.creator=Citerio, Giuseppe &rft.creator=Coccolini, Federico &rft.creator=Coimbra, Raul &rft.creator=Coniglio, Carlo &rft.creator=Fainardi, Enrico &rft.creator=Gupta, Deepak &rft.creator=Gurney, Jennifer M. &rft.creator=Hawrylux, Gregory W. J. &rft.creator=Helbok, Raimund &rft.creator=Hutchinson, Peter J. A. &rft.creator=Iaccarino, Corrado &rft.creator=Kolias, Angelos &rft.creator=Maier, Ronald W. &rft.creator=Martin, Matthew J. &rft.creator=Meyfroidt, Geert &rft.creator=Okonkwo, David O. &rft.creator=Rasulo, Frank &rft.creator=Rizoli, Sandro &rft.creator=Rubiano, Andres &rft.creator=Sahuquillo, Juan &rft.creator=Sams, Valerie G. &rft.creator=Servadei, Franco &rft.creator=Sharma, Deepak &rft.creator=Shutter, Lori &rft.creator=Stahel, Philip F. &rft.creator=Taccone, Fabio S. &rft.creator=Udy, Andrew &rft.creator=Zoerle, Tommaso &rft.creator=Agnoletti, Vanni &rft.creator=Bravi, Francesca &rft.creator=De Simone, Belinda &rft.creator=Kluger, Yoram &rft.creator=Martino, Costanza &rft.creator=Moore, Ernest E. &rft.creator=Sartelli, Massimo &rft.creator=Weber, Dieter &rft.creator=Robba, Chiara &rft.date=2023&rft.relation=http://research-repository.uwa.edu.au/en/publications/30559799-8058-4d2a-b10d-9f8bd793e1a3&rft.type=dataset&rft.language=English Access the data
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Abstract Background Severe traumatic brain-injured (TBI) patients should be primarily admitted to a hub trauma center (hospital with neurosurgical capabilities) to allow immediate delivery of appropriate care in a specialized environment. Sometimes, severe TBI patients are admitted to a spoke hospital (hospital without neurosurgical capabilities), and scarce data are available regarding the optimal management of severe isolated TBI patients who do not have immediate access to neurosurgical care. Methods A multidisciplinary consensus panel composed of 41 physicians selected for their established clinical and scientific expertise in the acute management of TBI patients with different specializations (anesthesia/intensive care, neurocritical care, acute care surgery, neurosurgery and neuroradiology) was established. The consensus was endorsed by the World Society of Emergency Surgery, and a modified Delphi approach was adopted. Results A total of 28 statements were proposed and discussed. Consensus was reached on 22 strong recommendations and 3 weak recommendations. In three cases, where consensus was not reached, no recommendation was provided. Conclusions This consensus provides practical recommendations to support clinician’s decision making in the management of isolated severe TBI patients in centers without neurosurgical capabilities and during transfer to a hub center.

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External Organisations
Ospedale Maggiore; Ospedale M. Bufalini; United Arab Emirates University; University of Pavia; MedStar Washington Hospital Center; Hebrew University of Jerusalem; Hunter Medical Research Institute; Scripps Clinic Medical Group; CNRS; Örebro University; University of Washington; University of Milan - Bicocca; Azienda Ospedaliera Universitaria Pisana; Loma Linda University Health; Ospedale Maggiore Carlo Alberto Pizzardi; University of Florence; All India Institute of Medical Sciences; Joint Base San Antonio; Cleveland Clinic Florida; Medizinische Universität Innsbruck; University of Cambridge; University of Modena and Reggio Emilia; University of Southern California; KULeuven BIOTEC; University of Pittsburgh Medical Center (UPMC); Brescia Civil Hospital; Hamad Medical Corporation; El Bosque University; Autonomous University of Barcelona; University of Cincinnati; Humanitas University; University of Pittsburgh; Rocky Vista University; Ghent University; Alfred Health; University of Milan; Hospital Santa Maria delle Croci; Centre Hospitalier Intercommunal de Poissy; Rambam Health Care Campus Israel; University of Colorado Denver; University of Genoa
Associated Persons
Edoardo Picetti (Contributor); Fausto Catena (Contributor); Fikri Abu-Zidan (Contributor); Luca Ansaloni (Contributor); Rocco A. Armonda (Contributor); Miklosh Bala (Contributor); Zsolt J. Balogh (Contributor); Alessandro Bertuccio (Contributor); Walt L. Biffl (Contributor); Pierre Bouzat (Contributor); Andras Buki (Contributor); Davide Cerasti (Contributor); Randall M. Chesnut (Contributor); Giuseppe Citerio (Contributor); Federico Coccolini (Contributor); Raul Coimbra (Contributor); Carlo Coniglio (Contributor); Enrico Fainardi (Contributor); Deepak Gupta (Contributor); Jennifer M. Gurney (Contributor); Gregory W. J. Hawrylux (Contributor); Raimund Helbok (Contributor); Peter J. A. Hutchinson (Contributor); Corrado Iaccarino (Contributor); Angelos Kolias (Contributor); Ronald W. Maier (Contributor); Matthew J. Martin (Contributor); Geert Meyfroidt (Contributor); David O. Okonkwo (Contributor); Frank Rasulo (Contributor); Sandro Rizoli (Contributor); Andres Rubiano (Contributor); Juan Sahuquillo (Contributor); Valerie G. Sams (Contributor); Franco Servadei (Contributor); Deepak Sharma (Contributor); Lori Shutter (Contributor); Philip F. Stahel (Contributor); Fabio S. Taccone (Contributor); Andrew Udy (Contributor); Tommaso Zoerle (Contributor); Vanni Agnoletti (Contributor); Francesca Bravi (Contributor); Belinda De Simone (Contributor); Yoram Kluger (Contributor); Costanza Martino (Contributor); Ernest E. Moore (Contributor); Massimo Sartelli (Contributor); Chiara Robba (Contributor)

Issued: 2023-04-13

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