Mortality reduction after implementing a clinical practice guidelines–based management protocol for severe traumatic brain injury

Arabi, Yaseen M.; Haddad, Samir; Tamim, Hani M.; Al-Dawood, Abdulaziz; Al-Qahtani, Saad; Ferayan, Ahmad; Al-Abdulmughni, Ibrahim; Al-Oweis, Jalal; Rugaan, Asia

doi:10.1016/j.jcrc.2009.05.004

« Previous Next »Journal of Critical Care
Volume 25, Issue 2 , Pages 190-195, June 2010

Mortality reduction after implementing a clinical practice guidelines–based management protocol for severe traumatic brain injury

Yaseen M. Arabi, MD, FCCP, FCCM
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia 11426
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia 11426
- Corresponding author. Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, King Fahad National Guard Hospital, Riyadh, K.S.A. Tel.: +966 1 2520088x18899 x18855x18877; fax: +966 1 2520088x18880.
Samir Haddad, MD, CES
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia 11426
Hani M. Tamim, PhD
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia 11426
Abdulaziz Al-Dawood, MD, FCCP, FRCP(C)
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia 11426
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia 11426
Saad Al-Qahtani, MD, FCCP, FRCP(C)
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia 11426
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia 11426
Ahmad Ferayan, MD, MBBS
- Division of Neurosurgery, Department of Surgery, King Abdualziz Medical City, Riyadh, Saudi Arabia 11426
Ibrahim Al-Abdulmughni, MD
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia 11426
Jalal Al-Oweis, MD
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia 11426
Asia Rugaan, MD
- Intensive Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia 11426

published online 10 July 2009.

Abstract

Introduction

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.

Conclusion

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.

Keywords: Guidelines, Mortality, Protocol, Severe Head Injury, Trauma, Traumatic Brain Injury