1 Division of Neurosurgery, Department of Surgery, University of Alberta and the University of Alberta Hospital , Edmonton, Alberta, Canada .
2 Faculty of Medicine, Jazan University , Jazan, Saudi Arabia .
J Neurotrauma. 2018 Jul 1;35(13):1407-1418. doi: 10.1089/neu.2017.5345. Epub 2018 Apr 25.
Traumatic brain injury (TBI) management based on Brain Trauma Foundation (BTF) guidelines is widely accepted and thought to improve outcome. The objectives of this study are to provide an overview of adherence to BTF guidelines and to explore which factors influence adherence. We conducted a search of relevant electronic bibliographic databases. Twenty articles met inclusion/exclusion criteria out of 666 articles screened. All were cohort studies. Wide variation in adherence to BTF guidelines was observed with a median of 66.2% (range 0-100%). The lowest median adherence was observed with surgical management (14%), whereas the highest was observed with oxygenation (100%), steroid (97.8%), and blood pressure recommendation (92.3%). Variability was primarily explained by the variation in the strength of evidence of each recommendation. Treating patients with higher severity of injury as well as treatment in a Level I trauma center positively influenced adherence. Overall, adherence to BTF guidelines varies. Further research is required to strengthen the current evidence and to identify factors related to adherence to guidelines from a professional prospective.
创伤性脑损伤（TBI）的管理基于脑外伤基金会（BTF）的指南，这被广泛接受并被认为可以改善预后。本研究的目的是提供对 BTF 指南的依从性的概述，并探讨哪些因素影响依从性。我们对相关的电子文献数据库进行了检索。在筛选出的 666 篇文章中，有 20 篇符合纳入/排除标准。所有研究均为队列研究。观察到对 BTF 指南的依从性存在广泛的差异，中位数为 66.2%（范围 0-100%）。手术管理的依从性最低（14%），而氧合（100%）、类固醇（97.8%）和血压建议（92.3%）的依从性最高。这种变异性主要归因于每个建议的证据强度的变化。治疗严重程度更高的患者以及在一级创伤中心进行治疗，会积极影响依从性。总体而言，对 BTF 指南的依从性存在差异。需要进一步研究来加强当前的证据，并从专业角度确定与指南依从性相关的因素。
