King's College Hospital NHS Foundation Trust, UK.
London South Bank University, UK.
Ann R Coll Surg Engl. 2023 May;105(5):400-406. doi: 10.1308/rcsann.2022.0031. Epub 2022 May 26.
Traumatic brain injury (TBI) is a leading cause of death and morbidity worldwide. Evidence-based guidelines for managing severe TBI have been available for over 25 years. However, adherence to guidelines remains variable despite evidence highlighting improvement in outcomes with individual recommendations. There is limited evidence to support a superior outcome with compliance to whole sets of recommendations. The aim of this review was to determine whether adherence to TBI guidelines as a package improves outcomes in adults and paediatric patients with severe TBI.
A structured literature search was conducted using the MEDLINE, Embase™, PubMed and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases. Studies were considered eligible for inclusion in this review if they were quantitative studies investigating the use of TBI guidelines in relation to one or more of the following outcomes: mortality, functional outcome and length of hospital stay.
Nine cohort studies were identified that fulfilled the inclusion criteria and answered the clinical question. A review of these papers was conducted.
Mortality after severe TBI improves with increasing adherence to evidence-based guidelines in both adults and children. The evidence also suggests that compliance with guideline recommendations results in improved functional outcomes and reduced length of hospital stay.
创伤性脑损伤（TBI）是全球范围内导致死亡和发病的主要原因。已有超过 25 年的时间提供了针对严重 TBI 的循证指南。然而，尽管有证据表明个别建议可以改善结果，但对指南的遵守仍然存在差异。只有有限的证据支持对整套建议的遵守可以带来更好的结果。本综述的目的是确定作为一个整体的 TBI 指南的遵守情况是否可以改善成人和儿童严重 TBI 患者的结局。
使用 MEDLINE、Embase™、PubMed 和 CINAHL（护理与联合健康文献累积索引）数据库进行了结构化文献检索。如果研究是定量研究，调查了 TBI 指南在以下一个或多个结果方面的使用情况：死亡率、功能结局和住院时间，则认为这些研究符合纳入本综述的标准。
确定了 9 项符合纳入标准并回答了临床问题的队列研究。对这些论文进行了综述。
在成人和儿童中，严重 TBI 后死亡率随着对基于证据的指南的遵守程度的增加而提高。证据还表明，遵守指南建议可改善功能结局并缩短住院时间。
