World Journal of Emergency Surgery (Jan 2023)
Early management of isolated severe traumatic brain injury patients in a hospital without neurosurgical capabilities: a consensus and clinical recommendations of the World Society of Emergency Surgery (WSES)
- Edoardo Picetti,
- Fausto Catena,
- Fikri Abu-Zidan,
- Luca Ansaloni,
- Rocco A. Armonda,
- Miklosh Bala,
- Zsolt J. Balogh,
- Alessandro Bertuccio,
- Walt L. Biffl,
- Pierre Bouzat,
- Andras Buki,
- Davide Cerasti,
- Randall M. Chesnut,
- Giuseppe Citerio,
- Federico Coccolini,
- Raul Coimbra,
- Carlo Coniglio,
- Enrico Fainardi,
- Deepak Gupta,
- Jennifer M. Gurney,
- Gregory W. J. Hawryluk,
- Raimund Helbok,
- Peter J. A. Hutchinson,
- Corrado Iaccarino,
- Angelos Kolias,
- Ronald W. Maier,
- Matthew J. Martin,
- Geert Meyfroidt,
- David O. Okonkwo,
- Frank Rasulo,
- Sandro Rizoli,
- Andres Rubiano,
- Juan Sahuquillo,
- Valerie G. Sams,
- Franco Servadei,
- Deepak Sharma,
- Lori Shutter,
- Philip F. Stahel,
- Fabio S. Taccone,
- Andrew Udy,
- Tommaso Zoerle,
- Vanni Agnoletti,
- Francesca Bravi,
- Belinda De Simone,
- Yoram Kluger,
- Costanza Martino,
- Ernest E. Moore,
- Massimo Sartelli,
- Dieter Weber,
- Chiara Robba
Affiliations
- Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital
- Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital
- Fikri Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University
- Luca Ansaloni
- Unit of General Surgery, San Matteo Hospital Pavia, University of Pavia
- Rocco A. Armonda
- Department of Neurosurgery, 71541MedStar Georgetown University Hospital
- Miklosh Bala
- Acute Care Surgery and Trauma Unit, Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem Kiriat Hadassah
- Zsolt J. Balogh
- Department of Traumatology, John Hunter Hospital, Hunter Medical Research Institute and University of Newcastle
- Alessandro Bertuccio
- Department of Neurosurgery, SS Antonio E Biagio E Cesare Arrigo Alessandria Hospital
- Walt L. Biffl
- Scripps Clinic Medical Group
- Pierre Bouzat
- Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Université Grenoble Alpes
- Andras Buki
- Department of Neurosurgery, Faculty of Medicine and Health, Örebro University
- Davide Cerasti
- Neuroradiology Unit, Azienda Ospedaliero-Universitaria of Parma
- Randall M. Chesnut
- Department of Neurological Surgery, University of Washington
- Giuseppe Citerio
- School of Medicine and Surgery, University of Milano-Bicocca
- Federico Coccolini
- Department of Emergency and Trauma Surgery, Pisa University Hospital
- Raul Coimbra
- Riverside University Health System Medical Center, Loma Linda University School of Medicine
- Carlo Coniglio
- Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi
- Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence
- Deepak Gupta
- Department of Neurosurgery, Neurosciences Centre and JPN Apex Trauma Centre, All India Institute of Medical Sciences
- Jennifer M. Gurney
- Department of Trauma, San Antonio Military Medical Center and the U.S. Army Institute of Surgical Research
- Gregory W. J. Hawryluk
- Cleveland Clinic
- Raimund Helbok
- Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck
- Peter J. A. Hutchinson
- Department of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge
- Corrado Iaccarino
- Neurosurgery Unit, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena
- Angelos Kolias
- National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge
- Ronald W. Maier
- Harborview Medical Center, University of Washington
- Matthew J. Martin
- Division of Trauma and Acute Care Surgery, Los Angeles County + USC Medical Center
- Geert Meyfroidt
- Department of Intensive Care, University Hospitals Leuven
- David O. Okonkwo
- Department of Neurological Surgery, University of Pittsburgh Medical Center
- Frank Rasulo
- Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital
- Sandro Rizoli
- Surgery Department, Section of Trauma Surgery, Hamad General Hospital (HGH)
- Andres Rubiano
- INUB-MEDITECH Research Group, Institute of Neurosciences, Universidad El Bosque
- Juan Sahuquillo
- Department of Neurosurgery, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona
- Valerie G. Sams
- Trauma Critical Care and Acute Care Surgery, Air Force Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati Medical Center
- Franco Servadei
- Department of Biomedical Sciences, Humanitas University
- Deepak Sharma
- Department of Anesthesiology and Pain Medicine and Neurological Surgery, University of Washington
- Lori Shutter
- Department of Critical Care Medicine, UPMC/University of Pittsburgh School of Medicine
- Philip F. Stahel
- College of Osteopathic Medicine, Rocky Vista University
- Fabio S. Taccone
- Department of Intensive Care, Hôpital Universitaire de Bruxelles
- Andrew Udy
- Department of Intensive Care and Hyperbaric Medicine, The Alfred
- Tommaso Zoerle
- Department of Pathophysiology and Transplantation, University of Milan
- Vanni Agnoletti
- Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital
- Francesca Bravi
- Healthcare Administration, Santa Maria Delle Croci Hospital
- Belinda De Simone
- Department of General, Digestive and Metabolic Minimally Invasive Surgery, Centre Hospitalier Intercommunal De Poissy/St Germain en Laye
- Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus
- Costanza Martino
- Department of Anesthesiology and Acute Care, Umberto I Hospital of Lugo, Ausl Della Romagna
- Ernest E. Moore
- Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado
- Massimo Sartelli
- Department of Surgery, Macerata Hospital
- Dieter Weber
- Department of General Surgery, Royal Perth Hospital, The University of Western Australia
- Chiara Robba
- Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience
- DOI
- https://doi.org/10.1186/s13017-022-00468-2
- Journal volume & issue
-
Vol. 18,
no. 1
pp. 1 – 12
Abstract
Abstract Background Severe traumatic brain-injured (TBI) patients should be primarily admitted to a hub trauma center (hospital with neurosurgical capabilities) to allow immediate delivery of appropriate care in a specialized environment. Sometimes, severe TBI patients are admitted to a spoke hospital (hospital without neurosurgical capabilities), and scarce data are available regarding the optimal management of severe isolated TBI patients who do not have immediate access to neurosurgical care. Methods A multidisciplinary consensus panel composed of 41 physicians selected for their established clinical and scientific expertise in the acute management of TBI patients with different specializations (anesthesia/intensive care, neurocritical care, acute care surgery, neurosurgery and neuroradiology) was established. The consensus was endorsed by the World Society of Emergency Surgery, and a modified Delphi approach was adopted. Results A total of 28 statements were proposed and discussed. Consensus was reached on 22 strong recommendations and 3 weak recommendations. In three cases, where consensus was not reached, no recommendation was provided. Conclusions This consensus provides practical recommendations to support clinician’s decision making in the management of isolated severe TBI patients in centers without neurosurgical capabilities and during transfer to a hub center.
Keywords
