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 M. Abu‐Zidan, Luca Ansaloni, Rocco A. Armonda, Miklosh Bala, Zsolt J. Balogh, Alessandro Bertuccio, Walt Biffl, Pierre Bouzat, András Büki, Davide Cerasti, Randall M. Chesnut, Giuseppe Citerio, Federico Coccolini, Raúl Coimbra, Carlo Coniglio, Enrico Fainardi, Deepak Gupta, Jennifer M. Gurney, Gregory W. J. Hawryluk, Raimund Helbok, Peter J. Hutchinson, Corrado Iaccarino, Angelos G. Kolias, Ronald W. Maier, Matthew J. Martin, Geert Meyfroidt, David O. Okonkwo, Frank Rasulo, Sandro Rizoli, Andrés M. Rubiano, Juan Sahuquillo, Valerie G. Sams, Franco Servadei, Deepak Sharma, Lori Shutter, Philip F. Stahel, Fabio Silvio 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
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.