Early management of isolated severe traumatic brain injury patients in a hospital without neurosurgical capabilities: a consensus and clinical recommendations of the World Society of Emergency Surgery (WSES)

Edoardo Picetti; Fausto Catena; Fikri Abu-Zidan; Luca Ansaloni; Rocco A Armonda; Miklosh Bala; Zsolt J Balogh; Alessandro Bertuccio; Walt L Biffl; Pierre Bouzat; Andras Buki; Davide Cerasti; Randall M Chesnut; Giuseppe Citerio; Federico Coccolini; Raul Coimbra; Carlo Coniglio; Enrico Fainardi; Deepak Gupta; Jennifer M Gurney; Gregory W J Hawryluk; Raimund Helbok; Peter J A Hutchinson; Corrado Iaccarino; Angelos Kolias; Ronald W Maier; Matthew J Martin; Geert Meyfroidt; David O Okonkwo; Frank Rasulo; Sandro Rizoli; Andres Rubiano; Juan Sahuquillo; Valerie G Sams; Franco Servadei; Deepak Sharma; Lori Shutter; Philip F Stahel; Fabio S Taccone; Andrew Udy; Tommaso Zoerle; Vanni Agnoletti; Francesca Bravi; Belinda De Simone; Yoram Kluger; Costanza Martino; Ernest E Moore; Massimo Sartelli; Dieter Weber; Chiara Robba

doi:10.1186/s13017-022-00468-2

Early management of isolated severe traumatic brain injury patients in a hospital without neurosurgical capabilities: a consensus and clinical recommendations of the World Society of Emergency Surgery (WSES)

World J Emerg Surg. 2023 Jan 9;18(1):5. doi: 10.1186/s13017-022-00468-2.

Authors

Edoardo Picetti¹, Fausto Catena², Fikri Abu-Zidan³, Luca Ansaloni⁴, Rocco A Armonda^{5

6}, Miklosh Bala⁷, Zsolt J Balogh⁸, Alessandro Bertuccio⁹, Walt L Biffl¹⁰, Pierre Bouzat¹¹, Andras Buki¹², Davide Cerasti¹³, Randall M Chesnut^{14

15

16}, Giuseppe Citerio^{17

18}, Federico Coccolini¹⁹, Raul Coimbra²⁰, Carlo Coniglio²¹, Enrico Fainardi²², Deepak Gupta²³, Jennifer M Gurney^{24

25}, Gregory W J Hawryluk²⁶, Raimund Helbok²⁷, Peter J A Hutchinson²⁸, Corrado Iaccarino²⁹, Angelos Kolias^{30

31}, Ronald W Maier³², Matthew J Martin³³, Geert Meyfroidt^{34

35}, David O Okonkwo³⁶, Frank Rasulo³⁷, Sandro Rizoli³⁸, Andres Rubiano³⁹, Juan Sahuquillo⁴⁰, Valerie G Sams⁴¹, Franco Servadei^{42

43}, Deepak Sharma⁴⁴, Lori Shutter⁴⁵, Philip F Stahel⁴⁶, Fabio S Taccone⁴⁷, Andrew Udy⁴⁸, Tommaso Zoerle^{49

50}, Vanni Agnoletti⁵¹, Francesca Bravi⁵², Belinda De Simone⁵³, Yoram Kluger⁵⁴, Costanza Martino⁵⁵, Ernest E Moore⁵⁶, Massimo Sartelli⁵⁷, Dieter Weber⁵⁸, Chiara Robba^{59

60}

Affiliations

¹ Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy. edoardopicetti@hotmail.com.
² Department of General and Emergency Surgery, Bufalini Hospital, Cesena, Italy.
³ The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates.
⁴ Unit of General Surgery, San Matteo Hospital Pavia, University of Pavia, Pavia, Italy.
⁵ Department of Neurosurgery, 71541MedStar Georgetown University Hospital, Washington, DC, USA.
⁶ Department of Neurosurgery, 8405MedStar Washington Hospital Center, Washington, DC, USA.
⁷ Acute Care Surgery and Trauma Unit, Department of General Surgery, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem Kiriat Hadassah, Jerusalem, Israel.
⁸ Department of Traumatology, John Hunter Hospital, Hunter Medical Research Institute and University of Newcastle, Newcastle, NSW, Australia.
⁹ Department of Neurosurgery, SS Antonio E Biagio E Cesare Arrigo Alessandria Hospital, Alessandria, Italy.
¹⁰ Scripps Clinic Medical Group, La Jolla, CA, USA.
¹¹ Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Université Grenoble Alpes, Grenoble, France.
¹² Department of Neurosurgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
¹³ Neuroradiology Unit, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy.
¹⁴ Department of Neurological Surgery, University of Washington, Seattle, WA, USA.
¹⁵ Department of Orthopedics and Sports Medicine, University of Washington, Seattle, WA, USA.
¹⁶ Department of Global Health, University of Washington, Seattle, WA, USA.
¹⁷ School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
¹⁸ Neuroscience Department, NeuroIntensive Care Unit, Hospital San Gerardo, ASST Monza, Monza, Italy.
¹⁹ Department of Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy.
²⁰ Riverside University Health System Medical Center, Loma Linda University School of Medicine, Riverside, CA, USA.
²¹ Department of Anesthesia, Intensive Care and Prehospital Emergency, Ospedale Maggiore Carlo Alberto Pizzardi, Bologna, Italy.
²² Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy.
²³ Department of Neurosurgery, Neurosciences Centre and JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
²⁴ Department of Trauma, San Antonio Military Medical Center and the U.S. Army Institute of Surgical Research, San Antonio, TX, 78234, USA.
²⁵ The Department of Defense Center of Excellence for Trauma, Joint Trauma System (JTS), JBSA Fort Sam Houston, San Antonio, TX, 78234, USA.
²⁶ Cleveland Clinic, 762 S. Cleveland-Massillon Rd, Akron, OH, 44333, USA.
²⁷ Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
²⁸ Department of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK.
²⁹ Neurosurgery Unit, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy.
³⁰ National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, UK.
³¹ Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital,, University of Cambridge, Cambridge, UK.
³² Harborview Medical Center, University of Washington, Seattle, WA, USA.
³³ Division of Trauma and Acute Care Surgery, Los Angeles County + USC Medical Center, Los Angeles, CA, USA.
³⁴ Department of Intensive Care, University Hospitals Leuven, Louvain, Belgium.
³⁵ Laboratory of Intensive Care Medicine, Katholieke Universiteit Leuven, Louvain, Belgium.
³⁶ Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
³⁷ Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy.
³⁸ Surgery Department, Section of Trauma Surgery, Hamad General Hospital (HGH), Doha, Qatar.
³⁹ INUB-MEDITECH Research Group, Institute of Neurosciences, Universidad El Bosque, Bogotá, Colombia.
⁴⁰ Department of Neurosurgery, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.
⁴¹ Trauma Critical Care and Acute Care Surgery, Air Force Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati Medical Center, Cincinnati, OH, USA.
⁴² Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
⁴³ Department of Neurosurgery, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
⁴⁴ Department of Anesthesiology and Pain Medicine and Neurological Surgery, University of Washington, Seattle, WA, USA.
⁴⁵ Department of Critical Care Medicine, UPMC/University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
⁴⁶ College of Osteopathic Medicine, Rocky Vista University, Parker, CO, USA.
⁴⁷ Department of Intensive Care, Hôpital Universitaire de Bruxelles, Brussels, Belgium.
⁴⁸ Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, 3004, Australia.
⁴⁹ Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
⁵⁰ Department of Anesthesia, Critical Care and Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
⁵¹ Anesthesia and Intensive Care Unit, AUSL Romagna, M. Bufalini Hospital, Cesena, Italy.
⁵² Healthcare Administration, Santa Maria Delle Croci Hospital, Ravenna, Italy.
⁵³ Department of General, Digestive and Metabolic Minimally Invasive Surgery, Centre Hospitalier Intercommunal De Poissy/St Germain en Laye, Poissy, France.
⁵⁴ Department of General Surgery, Rambam Health Care Campus, Haifa, Israel.
⁵⁵ Department of Anesthesiology and Acute Care, Umberto I Hospital of Lugo, Ausl Della Romagna, Lugo, Italy.
⁵⁶ Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA.
⁵⁷ Department of Surgery, Macerata Hospital, Macerata, Italy.
⁵⁸ Department of General Surgery, Royal Perth Hospital, The University of Western Australia, Perth, Australia.
⁵⁹ Anesthesia and Intensive Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neuroscience, Genoa, Italy.
⁶⁰ Department of Surgical Sciences and Integrated Sciences, University of Genoa, Genoa, Italy.

Abstract

Background: Severe traumatic brain-injured (TBI) patients should be primarily admitted to a hub trauma center (hospital with neurosurgical capabilities) to allow immediate delivery of appropriate care in a specialized environment. Sometimes, severe TBI patients are admitted to a spoke hospital (hospital without neurosurgical capabilities), and scarce data are available regarding the optimal management of severe isolated TBI patients who do not have immediate access to neurosurgical care.

Methods: A multidisciplinary consensus panel composed of 41 physicians selected for their established clinical and scientific expertise in the acute management of TBI patients with different specializations (anesthesia/intensive care, neurocritical care, acute care surgery, neurosurgery and neuroradiology) was established. The consensus was endorsed by the World Society of Emergency Surgery, and a modified Delphi approach was adopted.

Results: A total of 28 statements were proposed and discussed. Consensus was reached on 22 strong recommendations and 3 weak recommendations. In three cases, where consensus was not reached, no recommendation was provided.

Conclusions: This consensus provides practical recommendations to support clinician's decision making in the management of isolated severe TBI patients in centers without neurosurgical capabilities and during transfer to a hub center.

Keywords: Hub; Management; Spoke; Transfer; Traumatic brain injury.

MeSH terms

Brain
Brain Injuries, Traumatic* / surgery
Hospitalization
Hospitals
Humans
Neurosurgical Procedures