Guideline Adherence and Outcomes in Severe Adult Traumatic Brain Injury for the CHIRAG (Collaborative Head Injury and...

Area of Science:

• Neuroscience
• Critical Care Medicine
• Trauma Surgery

Background:

• Severe traumatic brain injury (TBI) is a leading cause of mortality and long-term disability.
• Adherence to established clinical guidelines in intensive care units (ICUs) is crucial for optimizing patient outcomes.
• The 2007 Brain Trauma Foundation (BTF) guidelines provide evidence-based recommendations for TBI management.

Purpose of the Study:

• To evaluate the impact of early adherence to 2007 BTF Guideline indicators on inpatient mortality in severe TBI patients.
• To compare guideline adherence rates and outcomes between a level 1 trauma center in India (JPNATC) and the U.S. (HMC).
• To assess the association between ICU guideline adherence and in-hospital mortality, and long-term functional outcomes (Glasgow Outcome Scale - GOS).

Main Methods:

• A comparative study was conducted at JPNATC (India) and HMC (U.S.) involving adult patients (>18 years) with severe TBI.
• Intensive care unit (ICU) guideline adherence for 17 indicators within the first 72 hours was quantified as a percentage at each site.
• In-hospital mortality and GOS scores at 3, 6, and 12 months post-discharge were the primary outcome measures.

Main Results:

• Guideline adherence rates were 74.9% (SD ±11.0) at JPNATC and 71.6% (SD ±10.4) at HMC, with similar in-hospital mortality (24% vs. 27%).
• At JPNATC, adherence below 65% was linked to higher inpatient mortality (aRR, 1.92; 95% CI, 1.11-3.33). A 1% increase in adherence correlated with a 3% decrease in mortality (aRR, 0.97; 95% CI, 0.95-0.99).
• While long-term outcomes generally improved, a significant proportion of patients discharged with favorable GOS scores (3-5) experienced deterioration at home by 3, 6, or 12 months.

Conclusions:

• Achieving early adherence to ICU guideline indicators for severe TBI is feasible and significantly associated with reduced in-hospital mortality, particularly in resource-limited settings like JPNATC.
• Despite variations in intracranial pressure (ICP) monitoring, in-hospital mortality rates were comparable between the two centers.
• Although functional outcomes can improve post-discharge, ongoing monitoring and support are necessary as patients with initially favorable GOS scores may deteriorate at home.