WSES consensus conference guidelines: monitoring and management of severe adult traumatic brain injury patients with polytrauma in the first 24 hours

Edoardo Picetti; Sandra Rossi; Fikri M Abu-Zidan; Luca Ansaloni; Rocco Armonda; Gian Luca Baiocchi; Miklosh Bala; Zsolt J Balogh; Maurizio Berardino; Walter L Biffl; Pierre Bouzat; Andras Buki; Marco Ceresoli; Randall M Chesnut; Osvaldo Chiara; Giuseppe Citerio; Federico Coccolini; Raul Coimbra; Salomone Di Saverio; Gustavo P Fraga; Deepak Gupta; Raimund Helbok; Peter J Hutchinson; Andrew W Kirkpatrick; Takahiro Kinoshita; Yoram Kluger; Ari Leppaniemi; Andrew I R Maas; Ronald V Maier; Francesco Minardi; Ernest E Moore; John A Myburgh; David O Okonkwo; Yasuhiro Otomo; Sandro Rizoli; Andres M Rubiano; Juan Sahuquillo; Massimo Sartelli; Thomas M Scalea; Franco Servadei; Philip F Stahel; Nino Stocchetti; Fabio S Taccone; Tommaso Tonetti; George Velmahos; Dieter Weber; Fausto Catena

doi:10.1186/s13017-019-0270-1

WSES consensus conference guidelines: monitoring and management of severe adult traumatic brain injury patients with polytrauma in the first 24 hours

World J Emerg Surg. 2019 Nov 29:14:53. doi: 10.1186/s13017-019-0270-1. eCollection 2019.

Authors

Edoardo Picetti¹, Sandra Rossi¹, Fikri M Abu-Zidan², Luca Ansaloni³, Rocco Armonda⁴, Gian Luca Baiocchi⁵, Miklosh Bala⁶, Zsolt J Balogh⁷, Maurizio Berardino⁸, Walter L Biffl⁹, Pierre Bouzat¹⁰, Andras Buki^{11

12}, Marco Ceresoli^{13

14}, Randall M Chesnut¹⁵, Osvaldo Chiara¹⁶, Giuseppe Citerio^{14

17}, Federico Coccolini³, Raul Coimbra¹⁸, Salomone Di Saverio¹⁹, Gustavo P Fraga²⁰, Deepak Gupta²¹, Raimund Helbok²², Peter J Hutchinson^{23

24}, Andrew W Kirkpatrick²⁵, Takahiro Kinoshita²⁶, Yoram Kluger²⁷, Ari Leppaniemi²⁸, Andrew I R Maas²⁹, Ronald V Maier³⁰, Francesco Minardi¹, Ernest E Moore³¹, John A Myburgh³², David O Okonkwo³³, Yasuhiro Otomo³⁴, Sandro Rizoli³⁵, Andres M Rubiano^{36

37}, Juan Sahuquillo³⁸, Massimo Sartelli³⁹, Thomas M Scalea⁴⁰, Franco Servadei⁴¹, Philip F Stahel⁴², Nino Stocchetti^{43

44}, Fabio S Taccone⁴⁵, Tommaso Tonetti¹, George Velmahos⁴⁶, Dieter Weber⁴⁷, Fausto Catena⁴⁸

Affiliations

¹ 1Department of Anesthesia and Intensive Care, Parma University Hospital, Via Gramsci 14, 43100 Parma, Italy.
² 2Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.
³ 3Department of General and Emergency Surgery, Bufalini Hospital, Cesena, Italy.
⁴ 4Department of Neurosurgery, Georgetown University School of Medicine, Washington, DC USA.
⁵ 5Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
⁶ 6Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
⁷ Department of Traumatology, John Hunter Hospital, University of Newcastle, Newcastle, NSW Australia.
⁸ 8Department of Anesthesiology, CTO Hospital, Turin, Italy.
⁹ 9Division of Trauma and Acute Care Surgery, Scripps Memorial Hospital, La Jolla, CA USA.
¹⁰ Department of Anaesthesiology and Critical Care, Grenoble Alps Trauma Center, University Hospital of Grenoble-Alpes, Grenoble Cedex, France.
¹¹ 11Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary.
¹² 12János Szentágothai Research Centre, University of Pécs, Pécs, Hungary.
¹³ 13Department of General and Emergency Surgery, ASST, San Gerardo Hospital, Monza, Italy.
¹⁴ 14School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.
¹⁵ 15Department of Neurological Surgery, University of Washington, Harborview Medical Center, Seattle, WA USA.
¹⁶ 16General Surgery and Trauma Team, University of Milano, ASST Niguarda Milano, Milan, Italy.
¹⁷ 17Neuro-Intensive Care, Department of Emergency and Intensive Care, ASST, San Gerardo Hospital, Monza, Italy.
¹⁸ 18Riverside University Health System Medical Center, Loma Linda University School of Medicine, Moreno Valley, CA USA.
¹⁹ 19Colorectal Unit, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
²⁰ 20Division of Trauma Surgery, Hospital de Clinicas, School of Medical Sciences, University of Campinas, Campinas, Brazil.
²¹ 21Department of Neurosurgery, All India Institute of Medical Sciences and associated Jai Prakash Narain Apex Trauma Centre, New Delhi, India.
²² 22Department of Neurology, Neurocritical Care Unit, Medical University of Innsbruck, Innsbruck, Austria.
²³ 23Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital and University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK.
²⁴ 24NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK.
²⁵ 25Departments of General Acute Care, Abdominal Wall Reconstruction and Trauma Surgery, Foothills Medical Centre, Calgary, AB Canada.
²⁶ Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan.
²⁷ 27Department of General Surgery, Rambam Health Campus, Haifa, Israel.
²⁸ 28Abdominal Center, Helsinki University Hospital Meilahti, Helsinki, Finland.
²⁹ Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium.
³⁰ 30Department of Surgery, Harborview Medical Centre, University of Washington School of Medicine, Seattle, WA USA.
³¹ 31Department of Trauma Surgery, Denver Health, Denver, CO USA.
³² 32Department of Intensive Care Medicine, St. George Clinical School, University of New South Wales and The George Institute for Global Health, Sydney, Australia.
³³ 33Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA USA.
³⁴ 34Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan.
³⁵ 35Department of Surgery, Trauma Surgery, Hamad General Hospital, Doha, Qatar.
³⁶ 36INUB/MEDITECH Research Group, El Bosque University, Bogotá, Colombia.
³⁷ MEDITECH Foundation, Clinical Research, Cali, Colombia.
³⁸ Neurosurgery Department, Vall d'Hebron University Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain.
³⁹ General Surgery, Macerata Hospital, Macerata, Italy.
⁴⁰ 40R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD USA.
⁴¹ Department of Neurosurgery, Humanitas University and Research Hospital, Milan, Italy.
⁴² 42College of Osteopathic Medicine, Rocky Vista University, Parker, CO USA.
⁴³ 43Neuro ICU Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
⁴⁴ 44Department of Physiopathology and Transplantation, Milan University, Milan, Italy.
⁴⁵ Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
⁴⁶ 46Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA.
⁴⁷ 47Trauma and General Surgery, Royal Perth Hospital, Perth, Australia.
⁴⁸ 48Department of Emergency Surgery, Parma University Hospital, Parma, Italy.

Abstract

The acute phase management of patients with severe traumatic brain injury (TBI) and polytrauma represents a major challenge. Guidelines for the care of these complex patients are lacking, and worldwide variability in clinical practice has been documented in recent studies. Consequently, the World Society of Emergency Surgery (WSES) decided to organize an international consensus conference regarding the monitoring and management of severe adult TBI polytrauma patients during the first 24 hours after injury. A modified Delphi approach was adopted, with an agreement cut-off of 70%. Forty experts in this field (emergency surgeons, neurosurgeons, and intensivists) participated in the online consensus process. Sixteen recommendations were generated, with the aim of promoting rational care in this difficult setting.

Keywords: Bleeding; Hemorrhage; Management; Monitoring; Polytrauma; Traumatic brain injury.

Publication types

Review

MeSH terms

Adult
Brain Injuries, Traumatic / complications
Brain Injuries, Traumatic / physiopathology
Brain Injuries, Traumatic / therapy*
Consensus Development Conferences as Topic
Delphi Technique
General Surgery / methods
General Surgery / organization & administration
General Surgery / trends
Guidelines as Topic
Humans
Monitoring, Physiologic / instrumentation
Monitoring, Physiologic / methods*
Monitoring, Physiologic / trends
Multiple Trauma / complications
Multiple Trauma / physiopathology
Patient Care Management / methods*
Patient Care Management / trends

Grants and funding

G0601025/MRC_/Medical Research Council/United Kingdom