Correlation Between Brain Trauma Foundation Guidelines and Published Severe Traumatic Brain Injury Research

Abstract

Four editions of the Brain Trauma Foundation's (BTF) evidence-based guidelines have been published to guide clinical management after severe traumatic brain injury (TBI) and increase TBI research. We reviewed the association between published clinical severe TBI research and BTF guideline year of publication and guideline chapter topics. Using PubMed, we searched for peer-reviewed articles on severe TBI research published between 1975 and 2019. The frequency and study design of publications on chapter topics included in all 4 BTF guideline editions was collected and the relationship with published TBI research examined using linear regression and the coefficient of determination (r2). A total of 845 relevant articles were identified, with an average of 19 articles published per year. There was an increase in the overall number of publications (r2=0.72), with the largest increase occurring between the third and the fourth guideline editions (r2=0.70, 31 articles/y). Across all 4 guideline editions, 54% (n=460) of publications were retrospective studies, 27.2% (n=230) prospective studies, 12% (n=101) randomized controlled trials, and 7.6% (n=64) meta-analyses/systematic reviews. Publication of retrospective study numbers increased the most (r2=0.61), followed by prospective observational studies and meta-analyses/systematic reviews (r2=0.47 each), and randomized controlled trials (r2=0.39). The 3 most highly published guideline chapter topic areas were ventilator-associated pneumonia (r2=0.70), hyperosmolar therapy (r2=0.47), and decompressive craniectomy (r2=0.41). In summary, the TBI research output increased over time and was associated with BTF guideline release. However, the increase in published TBI research was not consistent between serial editions of the BTF guidelines, and many studies did not incorporate high-quality prospective research designs.