title: An analysis of Brain Trauma Foundation traumatic brain injury guideline compliance and patient outcome.
abstract: BACKGROUND
  Evidence-based guidelines for the care of severe traumatic brain injury have been available from the Brain Trauma Foundation (BTF) since 1995. A total of 15 recommendations compose the current guidelines. Although each individual guideline has been validated in isolation, to date, little research has examined the guidelines in composite. We examined the relationship between compliance with the BTF severe TBI guidelines and mortality.
  
  
  METHODS
  In a Pennsylvania-verified, mature Level II trauma centre, patients with an admission Glasgow Coma Scale (GCS) ≤ 8 and an abnormal head CT from 2007 to 2012 were queried from the trauma registry. Exclusion criteria included: patients who sustained a non-survivable injury (AIS head 6), died ≤ 24 h, and/or were transferred to a paediatric trauma centre. Strict adherence to the BTF guidelines was determined in a binary fashion (yes/no). We then calculated each patient's percent compliance with total number of guidelines. Bivariate analysis was used to find significant predictors of mortality (p<0.05), including percent BTF guidelines compliance. Significant factors were added to a multivariable logistic regression model to look at mortality rates across the percent compliance spectrum.
  
  
  RESULTS
  185 Patients met inclusion criteria. Percent compliance ranged from 28.6% to 94.4%, (median=71.4%). Following adjustment for age, AIS head, and GCS motor, patients with 55-75% compliance (AOR: 0.20; 95%CI: 0.06-0.70) and >75% compliance (AOR: 0.27; 95%CI: 0.08-0.94) had reduced odds of mortality, as compared to <55% compliance to the BTF guidelines. When the unadjusted rate of mortality was compared across the compliance spectrum, the odds of mortality decreased as compliance increased until 75%, and then reversed.
  
  
  CONCLUSIONS
  Our data indicate that full compliance with all 15 severe TBI guidelines is difficult to achieve and may not be necessary to optimally care for patients.
authors: Trauma Services, Lancaster General Health,, 555 N, Duke Street, Lancaster, PA 17601, United States. Electronic address: jclee@lghealth.org.
authors: John C
authors: JC
authors: Lee
authors: Trauma Services, Lancaster General Health,, 555 N, Duke Street, Lancaster, PA 17601, United States. Electronic address: kr061@lghealth.org.
authors: Katelyn
authors: K
authors: Rittenhouse
authors: Trauma Services, Lancaster General Health,, 555 N, Duke Street, Lancaster, PA 17601, United States. Electronic address: kbupp2@lghealth.org.
authors: Katherine
authors: K
authors: Bupp
authors: Trauma Services, Lancaster General Health,, 555 N, Duke Street, Lancaster, PA 17601, United States. Electronic address: bg029@lghealth.org.
authors: Brian
authors: B
authors: Gross
authors: Trauma Services, Lancaster General Health,, 555 N, Duke Street, Lancaster, PA 17601, United States. Electronic address: atrogers89@gmail.com.
authors: Amelia
authors: A
authors: Rogers
authors: Trauma Services, Lancaster General Health,, 555 N, Duke Street, Lancaster, PA 17601, United States. Electronic address: frogers2@lghealth.org.
authors: Frederick B
authors: FB
authors: Rogers
authors: Trauma Services, Lancaster General Health,, 555 N, Duke Street, Lancaster, PA 17601, United States. Electronic address: mahorst@lghealth.org.
authors: Michael
authors: M
authors: Horst
authors: Trauma Services, Lancaster General Health,, 555 N, Duke Street, Lancaster, PA 17601, United States. Electronic address: lestrella2@lghealth.org.
authors: Lisa
authors: L
authors: Estrella
authors: Trauma Services, Lancaster General Health,, 555 N, Duke Street, Lancaster, PA 17601, United States. Electronic address: jthurmond2@lghealth.org.
authors: James
authors: J
authors: Thurmond
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D003422:Critical Care / Q000379:methods*; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data; D005260:Female; D015600:Glasgow Coma Scale; D019983:Guideline Adherence; D016489:Head Injuries, Closed / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D012189:Retrospective Studies; D014193:Trauma Centers
keywords: Compliance; Guidelines; Mortality; Traumatic brain injury