Association between implementation of clinical practice guidelines and outcome for traumatic brain injury.

BACKGROUND

Traumatic brain injury (TBI) is the leading cause of death in the population under 40 years of age in Western countries, and the same was true for Latvia in 1999. This indicated a strong need to improve the management of TBI. The Latvian Society of Neurosurgeons in collaboration with related societies created a dedicated working group, and the Guidelines for Medical Management of TBI in Latvia (Guidelines) were developed in 2001. This study aimed to assess the association between implementation of the Guidelines and the outcome of TBI patients.

METHODS

The Guidelines were printed and distributed to relevant clinical units and teaching institutions. To assess the impact of the Guidelines on the outcome of TBI, Latvian medical statistics were researched. All patients admitted to emergency departments and registered as either discharged or dead with a diagnosis of head trauma from 1998 to 2004 were included in a retrospective survey. The primary endpoint accepted for analysis was the hospital case fatality rate (HCFR).

RESULTS

The survey included 73,062 consecutive cases. The annual incidence rate of TBI admissions was stable during the period 1998 to 2004 (range 41.5-46.0/10,000), and the incidence of moderate and severe TBI (range 7.2-8.7/10,000) showed no significant trends. There was a reduction of HCFR from 3.7% during 1998-2000 to 2.6% during 2002-2004 (relative risk 0.72; 95% confidence interval 0.67-0.76; p = 0.03).

CONCLUSION

Implementation of the Guidelines was associated with a statistically significant decrease of HCFR in TBI patients.