title: Intensive care management of head-injured patients in Europe: a survey from the European brain injury consortium.
abstract: OBJECTIVE
  (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.
authors.affiliation: Terapia Intensiva Neuroscienze, Serv. Anestesia e Rianimazione-Ospedale Policlinico IRCCS, Via Francesco Sforza 35, 20122 Milan, Italy. stocchet@polic.cilea.it
authors.forename: N
authors.initials: N
authors.lastname: Stocchetti
authors.forename: K I
authors.initials: KI
authors.lastname: Penny
authors.forename: M
authors.initials: M
authors.lastname: Dearden
authors.forename: R
authors.initials: R
authors.lastname: Braakman
authors.forename: F
authors.initials: F
authors.lastname: Cohadon
authors.forename: F
authors.initials: F
authors.lastname: Iannotti
authors.forename: F
authors.initials: F
authors.lastname: Lapierre
authors.forename: A
authors.initials: A
authors.lastname: Karimi
authors.forename: A
authors.initials: A
authors.lastname: Maas
authors.forename: G D
authors.initials: GD
authors.lastname: Murray
authors.forename: J
authors.initials: J
authors.lastname: Ohman
authors.forename: L
authors.initials: L
authors.lastname: Persson
authors.forename: F
authors.initials: F
authors.lastname: Servadei
authors.forename: G M
authors.initials: GM
authors.lastname: Teasdale
authors.forename: T
authors.initials: T
authors.lastname: Trojanowski
authors.forename: A
authors.initials: A
authors.lastname: Unterberg
mesh_terms: D000328:Adult; D000368:Aged; D002560:Cerebrovascular Circulation; D006259:Craniocerebral Trauma / Q000503:physiopathology / Q000628:therapy*; D003422:Critical Care; D005060:Europe; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000628:therapy; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D017063:Outcome Assessment, Health Care; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D012121:Respiration, Artificial; D011795:Surveys and Questionnaires
chemical_list: D010100:Oxygen