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).
Edoardo Picetti, Fausto Catena, Fikri Abu-Zidan, Luca Ansaloni, Rocco A Armonda, Miklosh Bala, Zsolt J Balogh, Alessandro Bertuccio, Walt L Biffl, Pierre Bouzat, Andras Buki, Davide Cerasti, Randall M Chesnut, Giuseppe Citerio, Federico Coccolini, Raul Coimbra, Carlo Coniglio, Enrico Fainardi, Deepak Gupta, Jennifer M Gurney, Gregory W J Hawryluk, Raimund Helbok, Peter J A Hutchinson, Corrado Iaccarino, Angelos Kolias, Ronald W Maier, Matthew J Martin, Geert Meyfroidt, David O Okonkwo, Frank Rasulo, Sandro Rizoli, Andres Rubiano, Juan Sahuquillo, Valerie G Sams, Franco Servadei, Deepak Sharma, Lori Shutter, Philip F Stahel, Fabio S Taccone, Andrew Udy, Tommaso Zoerle, Vanni Agnoletti, Francesca Bravi, Belinda De Simone, Yoram Kluger, Costanza Martino, Ernest E Moore, Massimo Sartelli, Dieter Weber, Chiara Robba
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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.
期刊介绍：
The World Journal of Emergency Surgery is an open access, peer-reviewed journal covering all facets of clinical and basic research in traumatic and non-traumatic emergency surgery and related fields. Topics include emergency surgery, acute care surgery, trauma surgery, intensive care, trauma management, and resuscitation, among others.
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