Mortality reduction after implementing a clinical practice guidelines-based management protocol for severe traumatic brain injury.
BACKGROUND
The objective of this study was to examine the effect of implementing a clinical practice guidelines-based management protocol on the outcome of patients with severe traumatic brain injury (TBI).


METHODS
We carried out a pre-post guideline implementation study using previously collected data in the Intensive Care Unit (ICU). All patients older than 12 years with severe TBI, defined as a Glasgow Coma Scale score of 8 or less, from March 1999 to January 2001 (control group) and from February 2001 to December 2006 (protocol group) were identified and included in this study. Patients in the protocol group were managed using a clinical practice guidelines-based management protocol, derived from the guidelines published by the Brain Trauma Foundation. Primary outcome was hospital mortality, whereas the secondary outcome was ICU mortality. To assess whether the ICU protocol might have led to an increase in the number of surviving patients with severe disability, we examined the association of the protocol use and the need for tracheostomies, mechanical ventilation duration, and ICU and hospital length of stay (LOS) among survivors.


RESULTS
During the study period, a total of 434 patients met the inclusion criteria. After adjustment for several prognostic factors, the use of protocol was independently associated with a significant reduction in hospital and ICU mortality (odds ratio, 0.45; 95% confidence interval, 0.24-0.86; and odds ratio, 0.47; 95% confidence interval, 0.23-0.96, respectively). The use of the protocol was not associated with an increase in the need for tracheostomies, mechanical ventilation duration, ICU LOS, and hospital LOS.


CONCLUSIONS
The protocol implementation was associated with a reduction in hospital and ICU mortality. This improvement was not associated with an increase in the frequency of tracheostomies and in ICU or hospital LOS, suggesting that the improved survival was not associated with the increased number of surviving patients with severe disability and that the functional status might have also improved.
Arabi
Yaseen M
YM
Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia 11426. arabi@ngha.med.sa
Haddad
Samir
S
Tamim
Hani M
HM
Al-Dawood
Abdulaziz
A
Al-Qahtani
Saad
S
Ferayan
Ahmad
A
Al-Abdulmughni
Ibrahim
I
Al-Oweis
Jalal
J
Rugaan
Asia
A
D000328:Adult; D001930:Brain Injuries / Q000401:mortality / Q000628:therapy*; D002985:Clinical Protocols; D005260:Female; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012529:Saudi Arabia; D012720:Severity of Illness Index