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)

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.

Citing Articles

Endoplasmic reticulum stress and the unfolded protein response: emerging regulators in progression of traumatic brain injury.

Yang Y, Lu D, Wang M, Liu G, Feng Y, Ren Y Cell Death Dis. 2024; 15(2):156.

PMID: 38378666 PMC: 10879178. DOI: 10.1038/s41419-024-06515-x.

Early management of adult traumatic spinal cord injury in patients with polytrauma: a consensus and clinical recommendations jointly developed by the World Society of Emergency Surgery (WSES) & the European Association of Neurosurgical Societies....

Picetti E, Demetriades A, Catena F, Aarabi B, Abu-Zidan F, Alves O World J Emerg Surg. 2024; 19(1):4.

PMID: 38238783 PMC: 10795357. DOI: 10.1186/s13017-023-00525-4.

Frailty-originated early rehabilitation reduces postoperative delirium in brain tumor patients: Results from a prospective randomized study.

Yuan Y, Gu Q, Zhu M, Zhang Y, Lan M Asia Pac J Oncol Nurs. 2023; 10(8):100263.

PMID: 37497156 PMC: 10365981. DOI: 10.1016/j.apjon.2023.100263.

Care pathways and factors associated with interhospital transfer to neurotrauma centers for patients with isolated moderate-to-severe traumatic brain injury: a population-based study from the Norwegian trauma registry.

Cuevas-Ostrem M, Thorsen K, Wisborg T, Roise O, Helseth E, Jeppesen E Scand J Trauma Resusc Emerg Med. 2023; 31(1):34.

PMID: 37365649 PMC: 10294301. DOI: 10.1186/s13049-023-01097-7.

Correction: 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).

Picetti E, Catena F, Abu-Zidan F, Ansaloni L, Armonda R, Bala M World J Emerg Surg. 2023; 18(1):29.

PMID: 37024937 PMC: 10080738. DOI: 10.1186/s13017-023-00489-5.

References

Frontera J, Lewin 3rd J, Rabinstein A, Aisiku I, Alexandrov A, Cook A . Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage: A Statement for Healthcare Professionals from the Neurocritical Care Society and Society of Critical Care Medicine. Neurocrit Care. 2015; 24(1):6-46. DOI: 10.1007/s12028-015-0222-x. View

Hawryluk G, Aguilera S, Buki A, Bulger E, Citerio G, Cooper D . A management algorithm for patients with intracranial pressure monitoring: the Seattle International Severe Traumatic Brain Injury Consensus Conference (SIBICC). Intensive Care Med. 2019; 45(12):1783-1794. PMC: 6863785. DOI: 10.1007/s00134-019-05805-9. View

Maegele M . Coagulopathy and Progression of Intracranial Hemorrhage in Traumatic Brain Injury: Mechanisms, Impact, and Therapeutic Considerations. Neurosurgery. 2021; 89(6):954-966. DOI: 10.1093/neuros/nyab358. View

Joseph B, Pandit V, Meyer D, Butvidas L, Kulvatunyou N, Khalil M . The significance of platelet count in traumatic brain injury patients on antiplatelet therapy. J Trauma Acute Care Surg. 2014; 77(3):417-21. DOI: 10.1097/TA.0000000000000372. View

Thomas E, Czosnyka M, Hutchinson P . Calculation of cerebral perfusion pressure in the management of traumatic brain injury: joint position statement by the councils of the Neuroanaesthesia and Critical Care Society of Great Britain and Ireland (NACCS) and the Society of British.... Br J Anaesth. 2015; 115(4):487-8. DOI: 10.1093/bja/aev233. View

Spahn D, Bouillon B, Cerny V, Duranteau J, Filipescu D, Hunt B . The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care. 2019; 23(1):98. PMC: 6436241. DOI: 10.1186/s13054-019-2347-3. View

Rossi S, Zanier E, Mauri I, Columbo A, Stocchetti N . Brain temperature, body core temperature, and intracranial pressure in acute cerebral damage. J Neurol Neurosurg Psychiatry. 2001; 71(4):448-54. PMC: 1763520. DOI: 10.1136/jnnp.71.4.448. View

McConnell K, Newgard C, Mullins R, Arthur M, Hedges J . Mortality benefit of transfer to level I versus level II trauma centers for head-injured patients. Health Serv Res. 2005; 40(2):435-57. PMC: 1361150. DOI: 10.1111/j.1475-6773.2005.00366.x. View

Teasdale G, Maas A, Lecky F, Manley G, Stocchetti N, Murray G . The Glasgow Coma Scale at 40 years: standing the test of time. Lancet Neurol. 2014; 13(8):844-54. DOI: 10.1016/S1474-4422(14)70120-6. View

10.

Stocchetti N, Picetti E, Berardino M, Buki A, Chesnut R, Fountas K . Clinical applications of intracranial pressure monitoring in traumatic brain injury : report of the Milan consensus conference. Acta Neurochir (Wien). 2014; 156(8):1615-22. DOI: 10.1007/s00701-014-2127-4. View

11.

Hess A, Ramamoorthy J, Hess J . Perioperative Platelet Transfusions. Anesthesiology. 2021; 134(3):471-479. DOI: 10.1097/ALN.0000000000003670. View

12.

Ropper A . Hyperosmolar therapy for raised intracranial pressure. N Engl J Med. 2012; 367(8):746-52. DOI: 10.1056/NEJMct1206321. View

13.

Robba C, Poole D, McNett M, Asehnoune K, Bosel J, Bruder N . Mechanical ventilation in patients with acute brain injury: recommendations of the European Society of Intensive Care Medicine consensus. Intensive Care Med. 2020; 46(12):2397-2410. PMC: 7655906. DOI: 10.1007/s00134-020-06283-0. View

14.

Rubiano A, Vera D, Montenegro J, Carney N, Clavijo A, Carreno J . Recommendations of the Colombian Consensus Committee for the Management of Traumatic Brain Injury in Prehospital, Emergency Department, Surgery, and Intensive Care (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol.... J Neurosci Rural Pract. 2020; 11(1):7-22. PMC: 7055642. DOI: 10.1055/s-0040-1701370. View

15.

Adoni A, McNett M . The pupillary response in traumatic brain injury: a guide for trauma nurses. J Trauma Nurs. 2008; 14(4):191-6. DOI: 10.1097/01.jtn.0000318921.90627.fe. View

16.

Johnson A, Rott M, Kuchler A, Williams E, Cole F, Ramzy A . Direct to operating room trauma resuscitation: Optimizing patient selection and time-critical outcomes when minutes count. J Trauma Acute Care Surg. 2020; 89(1):160-166. DOI: 10.1097/TA.0000000000002703. View

17.

Marmarou A, Lu J, Butcher I, McHugh G, Murray G, Steyerberg E . Prognostic value of the Glasgow Coma Scale and pupil reactivity in traumatic brain injury assessed pre-hospital and on enrollment: an IMPACT analysis. J Neurotrauma. 2007; 24(2):270-80. DOI: 10.1089/neu.2006.0029. View

18.

Murray G, Butcher I, McHugh G, Lu J, Mushkudiani N, Maas A . Multivariable prognostic analysis in traumatic brain injury: results from the IMPACT study. J Neurotrauma. 2007; 24(2):329-37. DOI: 10.1089/neu.2006.0035. View

19.

Meyfroidt G, Bouzat P, Casaer M, Chesnut R, Hamada S, Helbok R . Management of moderate to severe traumatic brain injury: an update for the intensivist. Intensive Care Med. 2022; 48(6):649-666. DOI: 10.1007/s00134-022-06702-4. View

20.

Oddo M, Crippa I, Mehta S, Menon D, Payen J, Taccone F . Optimizing sedation in patients with acute brain injury. Crit Care. 2016; 20(1):128. PMC: 4857238. DOI: 10.1186/s13054-016-1294-5. View