title: Clinical practice guidelines in severe traumatic brain injury in Taiwan.
abstract: BACKGROUND
  Severe TBIs are major causes of disability and death in accidents. The Brain Trauma Foundation supported the first edition of the Guidelines for the Management of Severe Traumatic Brain Injury in 1995 and revised it in 2000. The recommendations in these guidelines are well accepted in the world. There are still some different views on trauma mechanisms, pathogenesis, and managements in different areas. Individualized guidelines for different countries would be necessary, and Taiwan is no exception.
  
  
  METHODS
  In November 2005, we organized the severe TBI guidelines committee and selected 9 topics, including ER treatment, ICP monitoring, CPP, fluid therapy, use of sedatives, nutrition, intracranial hypertension, seizure prophylaxis, and second-tier therapy. We have since searched key questions in these topics on Medline. References are classified into 8 levels of evidence: 1++, 1+, 1-, 2++, 2+, 2-, 3, and 4 based on the criteria of the SIGN.
  
  
  RESULTS
  Recommendations are formed and graded as A, B, C, and D. Grade A means that at least one piece of evidence is rated as 1++, whereas grade B means inclusion of studies rated as 2++. Grade C means inclusion of references rated as 2+, and grade D means levels of evidence rated as 3 or 4. Overall, 42 recommendations are formed. Three of these are rated as grade A, 13 as grade B, 21 as grade C, and 5 as grade D.
  
  
  CONCLUSIONS
  We have completed the first evidence-based, clinical practice guidelines for severe TBIs. It is hoped that the guidelines will provide concepts and recommendations to promote the quality of care for severe TBIs in Taiwan.
authors.affiliation: Department of Neurosurgery, Taipei Medical University-Wan Fang Medical Center, Taipei 116, Taiwan.
authors.forename: Kuo-Hsing
authors.initials: KH
authors.lastname: Liao
authors.forename: Cheng-Kuei
authors.initials: CK
authors.lastname: Chang
authors.forename: Hong-Chang
authors.initials: HC
authors.lastname: Chang
authors.forename: Kun-Chuan
authors.initials: KC
authors.lastname: Chang
authors.forename: Chieh-Feng
authors.initials: CF
authors.lastname: Chen
authors.forename: Tzu-Yung
authors.initials: TY
authors.lastname: Chen
authors.forename: Chi-Wen
authors.initials: CW
authors.lastname: Chou
authors.forename: Wen-Yu
authors.initials: WY
authors.lastname: Chung
authors.forename: Yung-Hsiao
authors.initials: YH
authors.lastname: Chiang
authors.forename: Kuo-Sheng
authors.initials: KS
authors.lastname: Hong
authors.forename: Sheng-Huang
authors.initials: SH
authors.lastname: Hsiao
authors.forename: Yu-Hone
authors.initials: YH
authors.lastname: Hsu
authors.forename: Hsu-Lin
authors.initials: HL
authors.lastname: Huang
authors.forename: Sheng-Chien
authors.initials: SC
authors.lastname: Huang
authors.forename: Ching-Chang
authors.initials: CC
authors.lastname: Hung
authors.forename: Sui-Sum
authors.initials: SS
authors.lastname: Kung
authors.forename: Ken N
authors.initials: KN
authors.lastname: Kuo
authors.forename: Kun-Hsing
authors.initials: KH
authors.lastname: Li
authors.forename: Jia-Wei
authors.initials: JW
authors.lastname: Lin
authors.forename: Tzu-Gan
authors.initials: TG
authors.lastname: Lin
authors.forename: Chien-Min
authors.initials: CM
authors.lastname: Lin
authors.forename: Chuan-Fa
authors.initials: CF
authors.lastname: Su
authors.forename: Ming-Ta
authors.initials: MT
authors.lastname: Tsai
authors.forename: Shin-Han
authors.initials: SH
authors.lastname: Tsai
authors.forename: Yu-Chih
authors.initials: YC
authors.lastname: Wang
authors.forename: Ta-Yu
authors.initials: TY
authors.lastname: Yang
authors.forename: Kuo-Fan
authors.initials: KF
authors.lastname: Yu
authors.forename: Wen-Ta
authors.initials: WT
authors.lastname: Chiu
mesh_terms: D001929:Brain Edema / Q000175:diagnosis / Q000628:therapy; D001930:Brain Injuries / Q000175:diagnosis* / Q000628:therapy*; D003128:Coma / Q000139:chemically induced; D004632:Emergency Medical Services / Q000592:standards*; D019317:Evidence-Based Medicine; D006801:Humans; D006985:Hyperventilation; D007036:Hypothermia, Induced / Q000592:standards; D019586:Intracranial Hypertension / Q000175:diagnosis / Q000628:therapy; D007427:Intracranial Pressure / Q000502:physiology; D008991:Monitoring, Physiologic / Q000592:standards; D013256:Steroids / Q000627:therapeutic use; D013624:Taiwan
chemical_list: D013256:Steroids