{"title":"Clinical practice guidelines in severe traumatic brain injury in Taiwan","authors":"Kuo-Hsing Liao MD , Cheng-Kuei Chang MD, PhD , Hong-Chang Chang MD , Kun-Chuan Chang MD , Chieh-Feng Chen MD , Tzu-Yung Chen MD , Chi-Wen Chou MD , Wen-Yu Chung MD , Yung-Hsiao Chiang MD, PhD , Kuo-Sheng Hong MD, PhD , Sheng-Huang Hsiao MD, PhD , Yu-Hone Hsu MD , Hsu-Lin Huang MD, PhD , Sheng-Chien Huang MD , Ching-Chang Hung MD , Sui-Sum Kung MD , Ken N. Kuo MD, PhD , Kun-Hsing Li MD , Jia-Wei Lin MD, PhD , Tzu-Gan Lin MD , Wen-Ta Chiu MD, PhD","doi":"10.1016/j.surneu.2009.07.004","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p><span>Severe TBIs are major causes of disability and death in accidents. The Brain Trauma Foundation supported the first edition of the </span><em>Guidelines for the Management of Severe Traumatic Brain Injury</em> in 1995 and revised it in 2000. The recommendations in these guidelines are well accepted in the world.</p><p>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.</p></div><div><h3>Methods</h3><p><span>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, </span>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.</p></div><div><h3>Results</h3><p>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.</p><p>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.</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":22153,"journal":{"name":"Surgical Neurology","volume":"72 ","pages":"Pages S66-S73"},"PeriodicalIF":0.0000,"publicationDate":"2009-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.surneu.2009.07.004","citationCount":"12","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgical Neurology","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0090301909006272","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 12
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.