Implementation of trauma unit guidance for inpatient management of adult traumatic brain injury: a cross-sectional survey.

Abstract

Purpose: Traumatic Brain Injury (TBI) is a leading cause of morbidity and mortality in adults, with a substantial number managed in non-specialist trauma units. Despite national guidance, variability persists in inpatient TBI management. This study aimed to evaluate the impact of a newly developed regional guideline for the inpatient care of adult TBI patients.

Materials and methods: A multidisciplinary team developed a structured inpatient guideline addressing neurological observation, medication safety, imaging, escalation to neurosurgery, and discharge criteria. The guideline was disseminated across 12 Trauma Units in the East of England Trauma Network. The launch of the guideline was conducted over Microsoft Teams, with invitations sent to all specialties and disciplines across the Trauma Network. To assess its perceived impact, an online survey evaluating confidence, knowledge, and current practice was conducted among clinicians pre- and post-guideline implementation.

Results: A total of 64 clinicians responded to the initial survey. Prior to the launch of the guideline, 39% of respondents reported the lack of clear guidance on when to perform repeat CT imaging for TBI, 78% were unsure of restarting anticoagulation, 55% were unclear on discharge criteria, and 83% were unaware of local neurorehabilitation pathways. Only 19% reported confidence in prescribing anti-epileptic drugs, and 8% in reversing anticoagulation. While GCS and pupil checks were commonly used, only 58% assessed limb power-a key sign of neurological deterioration. Overall, 90% supported the introduction of a structured inpatient guideline.

Conclusions: The findings highlight substantial gaps in clinician confidence and variability in practice for TBI patients managed in trauma units. The implementation of a regionally tailored inpatient guideline was well-received and has the potential to improve safety, consistency, and quality of TBI care outside specialist centres.