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Intensive care management of head injured patients in Europe: a survey from the European Brain Injury Consortium.

Stocchetti, Nino, Penny, Kay I, Dearden, Mark, Braakman, Reinder, Cohaden, Francois, Iannotti, Fausto, Lapierre, Francoise, Karimi, Abbi, Maas, Andrew, Murray, Gordon D, Ohman, Juha, Persson, Lennard, Servadei, Franco, Teasdale, Graham, Trojanowski, Tomasz and Unterberg, Andy (2001) Intensive care management of head injured patients in Europe: a survey from the European Brain Injury Consortium. Intensive Care Medicine, 27 (2). pp. 400-406. ISSN 1432-1238

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Abstract/Description

Objectives: (a) to describe current practice in the monitoring and treatment of moderate and severe head injuries in Europe; (b) to report on intracranial pressure and cerebral perfusion pressure monitoring, occurrence of measured and reported intracranial hypertension, and complications related to this monitoring; (c) to investigate the relationship between the severity of injury, the frequency of monitoring and management, and outcome. Methods: A three-page questionnaire comprising 60 items of information has been compiled by 67 centres in 12 European countries. Information was collected prospectively regarding all severe and moderate head injuries in adults (>16 years) admitted to neurosurgery within 24 h of injury. A total of 1005 adult head injury cases were enrolled in the study from 1 February 1995 to 30 April 1995. The Glasgow Outcome Scale was administered at 6 months. Results: Early surgery was performed in 346 cases (35%); arterial pressure was monitored invasively in 631 (68%), ICP in 346 (37%), and jugular bulb saturation in 173 (18%). Artificial ventilation was provided to 736 patients (78%). Intracranial hypertension was noted in 55% of patients in whom ICP was recorded, while it was suspected in only 12% of cases without ICP measurement. There were great differences in the use of ventilation and CPP monitoring among the centres. Mortality at 6 months was 31%. There was an association between an increased frequency of monitoring and intervention and an increased severity of injury; correspondingly, patients who more frequently underwent monitoring and ventilation had a less favourable outcome. Conclusions: In Europe there are great differences between centres in the frequency of CPP monitoring and ventilatory support applied to head-injured patients. ICP measurement disclosed a high rate of intracranial hypertension, which was not suspected in patients evaluated on a clinical basis alone. ICP monitoring was associated with a low rate of complications. Cases with severe neurological impairment, and with the worse outcome, were treated and monitored more intensively.

Item Type: Article
Print ISSN: 1432-1238
Electronic ISSN: 0342-4642
Uncontrolled Keywords: Head injury; Intracranial pressure; Cerebral perfusion pressure; Artificial ventilation; Outcome; Intensive care
University Divisions/Research Centres: Faculty of Health, Life & Social Sciences > School of Nursing, Midwifery and Social Care
Dewey Decimal Subjects: 600 Technology > 610 Medicine & health > 610 Medicine & health
600 Technology > 610 Medicine & health > 617 Surgery & related medical specialties
Library of Congress Subjects: R Medicine > RT Nursing
R Medicine > RD Surgery
Item ID: 1577
Depositing User: RAE Import
Date Deposited: 26 Feb 2008 16:44
Last Modified: 19 Mar 2012 16:37
URI: http://researchrepository.napier.ac.uk/id/eprint/1577

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