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.
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. A.; Bala, M.; Balogh, Z. J.; Bertuccio, A.; Biffl, W. L.; Bouzat, P.; Buki, A.; Cerasti, D.; Chesnut, R. M.; Citerio, G.; Coccolini, F.; Coimbra, R.; Coniglio, C.; Fainardi, E.; Gupta, D.; Gurney, J. M.; Hawrylux, G. W. J.; Helbok, R.; Hutchinson, P. J. A.; Iaccarino, C.; Kolias, A.; Maier, R. W.; Martin, M. J.; Meyfroidt, G.; Okonkwo, D. O.; Rasulo, F.; Rizoli, S.; Rubiano, A.; Sahuquillo, J.; Sams, V. G.; Servadei, F.; Sharma, D.; Shutter, L.; Stahel, P. F.; Taccone, F. S.; Udy, A.; Zoerle, T.; Agnoletti, V.; Bravi, F.; De Simone, B.; Kluger, Y.; Martino, C.; Moore, E. E.; Sartelli, M.; Weber, D.; Robba, C.. - In: WORLD JOURNAL OF EMERGENCY SURGERY. - ISSN 1749-7922. - 18:1(2023), pp. N/A-N/A. [10.1186/s13017-022-00468-2]
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)
Ansaloni L.;Bertuccio A.;Iaccarino C.;Agnoletti V.;Weber D.;
2023
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.
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