title: Adherence to Guidelines in Adult Patients with Traumatic Brain Injury: A Living Systematic Review.
abstract: Guidelines aim to improve the quality of medical care and reduce treatment variation. The extent to which guidelines are adhered to in the field of traumatic brain injury (TBI) is unknown. The objectives of this systematic review were to (1) quantify adherence to guidelines in adult patients with TBI, (2) examine factors influencing adherence, and (3) study associations of adherence to clinical guidelines and outcome. We searched EMBASE, MEDLINE, Cochrane Central, PubMed, Web of Science, PsycINFO, SCOPUS, CINAHL, and grey literature in October 2014. We included studies of evidence-based (inter)national guidelines that examined the acute treatment of adult patients with TBI. Methodological quality was assessed using the Research Triangle Institute item bank and Quality in Prognostic Studies Risk of Bias Assessment Instrument. Twenty-two retrospective and prospective observational cohort studies, reported in 25 publications, were included, describing adherence to 13 guideline recommendations. Guideline adherence varied considerably between studies (range 18-100%) and was higher in guideline recommendations based on strong evidence compared with those based on lower evidence, and lower in recommendations of relatively more invasive procedures such as craniotomy. A number of patient-related factors, including age, Glasgow Coma Scale, and intracranial pathology, were associated with greater guideline adherence. Guideline adherence to Brain Trauma Foundation guidelines seemed to be associated with lower mortality. Guideline adherence in TBI is suboptimal, and wide variation exists between studies. Guideline adherence may be improved through the development of strong evidence for guidelines. Further research specifying hospital and management characteristics that explain variation in guideline adherence is warranted.
authors.affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Maryse C
authors.initials: MC
authors.lastname: Cnossen
authors.affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Annemieke C
authors.initials: AC
authors.lastname: Scholten
authors.affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Hester F
authors.initials: HF
authors.lastname: Lingsma
authors.affiliation: Center for Excellence in Traumatic Brain Injury Research, National Trauma Research Institute, The Alfred Hospital, Monash University, Melbourne, Australia.|Cochrane Consumers and Communication Review Group, Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Melbourne, Australia.
authors.forename: Anneliese
authors.initials: A
authors.lastname: Synnot
authors.affiliation: Australian Satellite of Cochrane EPOC group, Melbourne, Australia.
authors.forename: Emma
authors.initials: E
authors.lastname: Tavender
authors.affiliation: Center for Excellence in Traumatic Brain Injury Research, National Trauma Research Institute, The Alfred Hospital, Monash University, Melbourne, Australia.
authors.forename: Dashiell
authors.initials: D
authors.lastname: Gantner
authors.affiliation: Department of Emergency Medicine, University of Sheffield, University of Manchester and Salford Royal Hospital NHS Foundation Trust, and 2012 NICE Head Injury Guideline Development Group, United Kingdom.
authors.forename: Fiona
authors.initials: F
authors.lastname: Lecky
authors.affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Ewout W
authors.initials: EW
authors.lastname: Steyerberg
authors.affiliation: Department of Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Polinder
mesh_terms: D000328:Adult; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D002986:Clinical Trials as Topic / Q000379:methods; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D011446:Prospective Studies; D012189:Retrospective Studies
keywords: adherence; compliance; guidelines; living systematic review; protocol; traumatic brain injury