title: Predictors of compliance with the evidence-based guidelines for traumatic brain injury care: a survey of United States trauma centers.
abstract: BACKGROUND
  In 1995, evidence-based guidelines for the management of severe traumatic brain injury (TBI) were published and disseminated. Information regarding their implementation is limited.
  
  
  METHODS
  During 1999 to 2000, we contacted all designated U.S. trauma centers caring for adults with severe TBI to determine the degree of guideline compliance and to identify predictors.
  
  
  RESULTS
  Of 924 centers identified, 828 participated (90%). Four hundred thirty-three with intensive care units caring for severe TBI were surveyed. Three hundred ninety-five centers transferring patients were excluded. Full guideline compliance was rare (n = 68 [16%]). In multivariate analyses, treatment protocols (odds ratio [OR], 3.6; 95% confidence interval [CI], 1.9-6.6), neurosurgery residency program (OR, 5.0; 95% CI, 2.6-9.8), and state (OR, 2.7; 95% CI, 0.62-12) or American College of Surgeons (OR, 5.1; 95% CI, 1.1-23) designation increased the likelihood of full compliance versus noncompliance.
  
  
  CONCLUSIONS
  Although evidence-based guidelines were published and disseminated in 1995, implementation is infrequent. Focus must turn to changing physician practice and transport decisions to provide guideline-compliant care and improve patient outcome.
authors.affiliation: GH Sergievsky Center, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA. dch5@columbia.edu
authors.forename: Dale C
authors.initials: DC
authors.lastname: Hesdorffer
authors.forename: Jamshid
authors.initials: J
authors.lastname: Ghajar
authors.forename: Laura
authors.initials: L
authors.lastname: Iacono
mesh_terms: D001930:Brain Injuries / Q000628:therapy*; D003625:Data Collection; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D017410:Practice Guidelines as Topic / Q000592:standards; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014481:United States