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Mortality reduction after implementing a clinical practice guidelines-based management protocol for severe traumatic
Yaseen M Arabi1, Samir Haddad, Hani M Tamim
1Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia 11426. arabi@ngha.med.sa
Insights
Implementing a clinical practice guidelines-based protocol significantly reduced hospital and ICU mortality for severe traumatic brain injury (TBI) patients. This TBI management improvement did not increase long-term disability or resource utilization.
Area of Science:
- Neuroscience
- Critical Care Medicine
- Public Health
Background:
- Severe traumatic brain injury (TBI) presents significant mortality and morbidity challenges.
- Clinical practice guidelines aim to standardize and improve TBI patient management.
- Evaluating protocol implementation is crucial for optimizing patient outcomes.
Purpose of the Study:
- To assess the impact of a clinical practice guidelines-based management protocol on severe TBI patient outcomes.
- To determine if protocol implementation affects hospital and Intensive Care Unit (ICU) mortality.
- To investigate potential increases in disability among survivors.
Main Methods:
- A pre-post guideline implementation study design was employed.
- Data from severe TBI patients (Glasgow Coma Scale ≤ 8, age > 12) were analyzed.
- Outcomes included hospital mortality, ICU mortality, tracheostomy rates, ventilation duration, and length of stay (LOS).
Main Results:
- Protocol implementation was associated with a significant reduction in hospital mortality (OR 0.45) and ICU mortality (OR 0.47).
- No significant increase was observed in tracheostomies, mechanical ventilation duration, or ICU/hospital LOS among survivors.
- Adjustments were made for key prognostic factors.
Conclusions:
- Clinical practice guidelines-based protocol implementation effectively reduces mortality in severe TBI patients.
- Improved survival was not linked to increased long-term disability or resource use.
- The findings suggest potential improvements in functional status post-protocol implementation.
Introduction:
The objective of this study was to examine the effect of implementing a clinical practice guidelines-based management protocol on the outcome of patients with severe traumatic brain injury (TBI).
Methods:
We carried out a pre-post guideline implementation study using previously collected data in the Intensive Care Unit (ICU). All patients older than 12 years with severe TBI, defined as a Glasgow Coma Scale score of 8 or less, from March 1999 to January 2001 (control group) and from February 2001 to December 2006 (protocol group) were identified and included in this study. Patients in the protocol group were managed using a clinical practice guidelines-based management protocol, derived from the guidelines published by the Brain Trauma Foundation. Primary outcome was hospital mortality, whereas the secondary outcome was ICU mortality. To assess whether the ICU protocol might have led to an increase in the number of surviving patients with severe disability, we examined the association of the protocol use and the need for tracheostomies, mechanical ventilation duration, and ICU and hospital length of stay (LOS) among survivors.
Results:
During the study period, a total of 434 patients met the inclusion criteria. After adjustment for several prognostic factors, the use of protocol was independently associated with a significant reduction in hospital and ICU mortality (odds ratio, 0.45; 95% confidence interval, 0.24-0.86; and odds ratio, 0.47; 95% confidence interval, 0.23-0.96, respectively). The use of the protocol was not associated with an increase in the need for tracheostomies, mechanical ventilation duration, ICU LOS, and hospital LOS.
Conclusion:
The protocol implementation was associated with a reduction in hospital and ICU mortality. This improvement was not associated with an increase in the frequency of tracheostomies and in ICU or hospital LOS, suggesting that the improved survival was not associated with the increased number of surviving patients with severe disability and that the functional status might have also improved.
