• Surg Neurol · Dec 2009

    Practice Guideline

    Clinical practice guidelines in severe traumatic brain injury in Taiwan.

    • Kuo-Hsing Liao, Cheng-Kuei Chang, Hong-Chang Chang, Kun-Chuan Chang, Chieh-Feng Chen, Tzu-Yung Chen, Chi-Wen Chou, Wen-Yu Chung, Yung-Hsiao Chiang, Kuo-Sheng Hong, Sheng-Huang Hsiao, Yu-Hone Hsu, Hsu-Lin Huang, Sheng-Chien Huang, Ching-Chang Hung, Sui-Sum Kung, Ken N Kuo, Kun-Hsing Li, Jia-Wei Lin, Tzu-Gan Lin, Chien-Min Lin, Chuan-Fa Su, Ming-Ta Tsai, Shin-Han Tsai, Yu-Chih Wang, Ta-Yu Yang, Kuo-Fan Yu, Wen-Ta Chiu, and Brain Trauma Foundation.
    • Department of Neurosurgery, Taipei Medical University-Wan Fang Medical Center, Taipei 116, Taiwan.
    • Surg Neurol. 2009 Dec 1;72 Suppl 2:S66-73; discussion S73-4.

    BackgroundSevere 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.MethodsIn 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.ResultsRecommendations 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.ConclusionsWe 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.

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