Clinical practice guidelines in severe traumatic brain injury in Taiwan.
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.
Liao
Kuo-Hsing
KH
Department of Neurosurgery, Taipei Medical University-Wan Fang Medical Center, Taipei 116, Taiwan.
Chang
Cheng-Kuei
CK
Chang
Hong-Chang
HC
Chang
Kun-Chuan
KC
Chen
Chieh-Feng
CF
Chen
Tzu-Yung
TY
Chou
Chi-Wen
CW
Chung
Wen-Yu
WY
Chiang
Yung-Hsiao
YH
Hong
Kuo-Sheng
KS
Hsiao
Sheng-Huang
SH
Hsu
Yu-Hone
YH
Huang
Hsu-Lin
HL
Huang
Sheng-Chien
SC
Hung
Ching-Chang
CC
Kung
Sui-Sum
SS
Kuo
Ken N
KN
Li
Kun-Hsing
KH
Lin
Jia-Wei
JW
Lin
Tzu-Gan
TG
Lin
Chien-Min
CM
Su
Chuan-Fa
CF
Tsai
Ming-Ta
MT
Tsai
Shin-Han
SH
Wang
Yu-Chih
YC
Yang
Ta-Yu
TY
Yu
Kuo-Fan
KF
Chiu
Wen-Ta
WT
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
D013256:Steroids