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Guidelines for the management of severe head injury: are emergency physicians following them?
| Content Provider | Semantic Scholar |
|---|---|
| Author | Huizenga, James E. |
| Copyright Year | 2002 |
| Abstract | UNLABELLED The Brain Trauma Foundation published "Guidelines for the Management of Severe Head Injury" in 1995. These evidence-based clinical guidelines (CGs) recommended against prophylactic hyperventilation and glucocorticoid use and advocated for aggressive blood pressure (BP) resuscitation, and the careful use of mannitol. OBJECTIVE To survey Michigan emergency physicians (MEPs) to test their adherence to these guidelines. METHODS An anonymous mail survey was sent to all 566 MEPs who are members of the American College of Emergency Physicians. Three clinical scenarios involving severe head injury were presented, all with Glasgow Coma Scale (GCS) scores of 8 or less. The physicians were asked to choose from 15 diagnostic and treatment options, which included: intubation and hyperventilation, BP resuscitation, intravenous (IV) mannitol administration, and IV glucocorticoid administration. RESULTS Three hundred nineteen (56%) surveys were returned. Forty-six percent [95% confidence interval (95% CI) = 40% to 51%] of the MEPs elected to use prophylactic hyperventilation; very few administered IV glucocorticoids. Seventy-eight percent (95% CI = 75% to 81%) corrected hypotension with systolic BP < 90 mm Hg; 83% (95% CI = 80% to 86%) also administered mannitol appropriately. CONCLUSIONS A majority of MEPs are managing severe head injury patients in accordance with the "Guidelines for the Management of Severe Head Injury," with the exception of avoiding prophylactic hyperventilation. More education and/or exposure to the evidence regarding prophylactic hyperventilation of severely head injured patients may improve adherence to the guidelines. |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | https://deepblue.lib.umich.edu/bitstream/handle/2027.42/74731/aemj.9.8.806.pdf;jsessionid=06EA582284944E5A4755AA55F6FE42A2?sequence=1 |
| PubMed reference number | 12153886v1 |
| Volume Number | 9 |
| Issue Number | 8 |
| Journal | Academic emergency medicine : official journal of the Society for Academic Emergency Medicine |
| Language | English |
| Access Restriction | Open |
| Subject Keyword | Choose (action) Comatose Condoms, Unspecified Confidence Intervals Craniocerebral Trauma Dietary Mercury Eighty Guidelines Head and Neck Neoplasms Hematological Disease Hyperglycemic Hyperosmolar Nonketotic Coma Intubation Mannitol Patients Resuscitation procedure Scientific Publication Traumatic Brain Injury Wounds and Injuries numeral 19 pediatric intracranial germ cell brain tumor |
| Content Type | Text |
| Resource Type | Article |
