Australian and New Zealand Intensive Care Research Centre, Monash University, Level 3, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
Department of Intensive Care, Alfred Health, Melbourne, Australia.
Neurocrit Care. 2022 Dec;37(3):744-753. doi: 10.1007/s12028-022-01551-x. Epub 2022 Aug 10.
Management of patients with severe traumatic brain injury (sTBI) is highly variable and inconsistently aligned with evidence derived from high-quality trials, including those examining intravenous fluid resuscitation and use of decompressive craniectomy surgery. This study explored the barriers and facilitators of general and specific evidence-based practices in sTBI from the perspectives of stakeholder clinicians.
This was a qualitative study of semistructured interviews conducted with specialist clinicians responsible for acute care of patients with sTBI. Interview analysis was guided by the Theoretical domains framework (TDF), and key themes were mapped to relevant TDF behavioral domains.
Ten neurosurgeons, 12 intensive care specialists, and three trauma physicians from six high-income countries participated between May 2020 and May 2021. Key TDF domains were environmental context and resources, social influences, and beliefs about consequences. Evidence-aligned management of patients with sTBI is perceived to be facilitated by admission to academic research-oriented hospitals, development of local practice protocols, and interdisciplinary collaboration. Determinants of specific practices varied and included health policy change for fluid resuscitation and development of patient-centered goals for surgical decision-making.
In choosing interventions for patients with sTBI, clinicians integrate local environmental, social, professional, and emotional influences with evidence and associated clinical practice guideline recommendations. This study highlights determinants of evidence-based practice that may inform implementation efforts and thereby improve outcomes for patients with sTBI.
严重创伤性脑损伤（sTBI）患者的管理方式差异很大，且与高质量试验得出的证据不一致，包括静脉输液复苏和去骨瓣减压手术的研究。本研究从利益相关者临床医生的角度探讨了 sTBI 中一般和具体循证实践的障碍和促进因素。
这是一项对负责 sTBI 急性护理的专科临床医生进行半结构式访谈的定性研究。访谈分析以理论领域框架（TDF）为指导，将关键主题映射到相关 TDF 行为领域。
2020 年 5 月至 2021 年 5 月，来自六个高收入国家的 10 名神经外科医生、12 名重症监护专家和 3 名创伤医生参与了研究。关键 TDF 领域包括环境背景和资源、社会影响以及对后果的信念。sTBI 患者的循证管理被认为得益于进入学术研究型医院、制定当地实践方案和跨学科合作。特定实践的决定因素各不相同，包括液体复苏的卫生政策变化和制定以患者为中心的手术决策目标。
在为 sTBI 患者选择干预措施时，临床医生将当地环境、社会、专业和情感影响与证据及相关临床实践指南建议相结合。本研究强调了循证实践的决定因素，这可能为实施工作提供信息，并由此改善 sTBI 患者的结局。
