Guidelines for the management of severe head injury: are emergency physicians following them?
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.
Huizenga
James E
JE
Department of Emergency Medicine, Wright State University, Dayton, OH, USA.
Zink
Brian J
BJ
Maio
Ronald F
RF
Hill
Elizabeth M
EM
D000328:Adult; D016001:Confidence Intervals; D006259:Craniocerebral Trauma / Q000145:classification / Q000628:therapy*; D004635:Emergency Medicine; D005260:Female; D015600:Glasgow Coma Scale; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D017410:Practice Guidelines as Topic / Q000592:standards*; D011795:Surveys and Questionnaires