A study by the Los Angeles County Trauma Consortium suggests that compliance with the Brain Trauma Foundation guidelines for treating traumatic brain injury (TBI) may not guarantee better results for patients.
In the study, published online in JAMA Surgery, the consortium analyzed 2009 and 2010 data from all 14 Los Angeles County trauma centers.
According to a news release from the University of California – Los Angeles Health Sciences, the consortium reportedly found no evidence that compliance with the Brain Trauma Foundation guidelines for treating TBI—published 2 decades ago—has led to lower mortality rates.
“There is no direct connection between the rate at which a hospital does what it is supposed to do for traumatic brain injury patients and how likely their patients are to die from their injuries after we adjust for other important patient characteristics,” says Aaron Dawes, MD, the study’s lead author and a resident in general surgery at the David Geffen School of Medicine at UCLA, in the release.
The consortium is composed of health services researchers from UCLA and the University of Southern California, and representatives of the trauma centers and the county’s Emergency Medical Services Agency, according to the release.
In their study, they calculated how often trauma centers follow the guidelines, which include management strategies and specific criteria for use of two invasive procedures—intracranial pressure monitoring and craniotomy.
The release explains that after analyzing data from 734 adults who sustained severe TBI, they found that the percentage of patients who died from their injuries varied by medical center, but ranged from 20% to 50%; and risk-adjusted mortality rates—which take into account the patients’ age and other medical conditions—ranged from 24.3% to 56.7%.
Also, the release explains, they found that only 46.1% of patients whose injuries called for intracranial pressure monitoring according to the guidelines actually underwent monitor placement, and only 45.6% of the patients whose injuries called for craniotomy underwent the procedure; and that hospitals’ compliance with the guidelines ranged from 9.6% to 65.2% for intracranial pressure monitoring, and from 6.7% to 76.2% for craniotomies.
“Overall, patients received the procedures recommended by the guidelines only about half the time—and even less at some centers,” Dawes states in the release.
“This tells us that we need to do a better job providing evidence-based care, but it also showed that the pattern of how often hospitals follow the guidelines does not appear to be associated with other, more validated measures of hospital quality,” he continues.
The researchers suggest in the release that the study highlights a key problem with the trauma foundation guidelines: They address only whether intracranial monitoring should be performed, but not how the clinical team should use the information that the monitors provide.
“For example, two identical patients could have monitors placed,” says Dawes, also a Robert Wood Johnson Foundation Clinical Scholar, in the release.
“But one patient’s medical team might not use information from the monitor—or might not use it as well as the other patient’s team. Blunt metrics like the ones we studied simply can’t get at that level of clinical decision-making,” he continues.
These findings already have prompted consortium members to re-evaluate how they treat brain trauma, which could lead to better care for Los Angeles patients, Dawes notes in the release.
There were some limitations to the study, per the release. It included only patients with the most severe TBIs in Los Angeles County, so the results may not apply to other regions or people with less severe injuries. Also, practices at some medical centers might have changed during the time between data collection and data analysis. Finally, the sample size at some hospitals was too small to make certain comparisons.
“Despite improvements in care, mortality from [traumatic brain injury] remains both common and variable from hospital to hospital,” the consortium writes in the study, per the release.
“Our results demonstrate no association between hospitals’ compliance with two [Brain Trauma Foundation] guidelines and risk-adjusted mortality, suggesting that neither measure should be used as an independent marker of hospital quality,” it continues.
[Source(s): University of California – Los Angeles Health Sciences, Science Daily]
