• Victor Volovici, Ari Ercole, Giuseppe Citerio, Nino Stocchetti, Iain K Haitsma, Jilske A Huijben, Dirven Clemens M F CMF Department of Neurosurgery, Erasmus MC, Rotterdam, the Netherlands., Mathieu van der Jagt, Ewout W Steyerberg, David Nelson, Maryse C Cnossen, Maas Andrew I R AIR Department of Neurosurgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium., Suzanne Polinder, David K Menon, Hester F Lingsma, and CENTER-TBI collaborators.
• Department of Neurosurgery, Erasmus MC, Rotterdam, the Netherlands; Center for Medical Decision Making, Department of Public Health, Erasmus MC, Rotterdam, the Netherlands. Electronic address: v.volovici@erasmusmc.nl.
• World Neurosurg. 2019 May 1; 125: e515-e520.

ObjectiveGuidelines may reduce practice variation and optimize patient care. We aimed to study differences in guideline use in the management of traumatic brain injury (TBI) patients and analyze reasons for guideline non-adherence.MethodsAs part of a prospective, observational, multicenter European cohort study, participants from 68 centers in 20 countries were asked to complete 72-item questionnaires regarding their management of severe TBI. Six questions with multiple sub-questions focused on guideline use and implementation.ResultsQuestionnaires were completed by 65 centers. Of these, 49 (75%) reported use of the Brain Trauma Foundation guidelines for the medical management of TBI or related institutional protocols, 11 (17%) used no guidelines, and 5 used other guidelines (8%). Of 54 centers reporting use of any guidelines, 41 (75%) relied on written guidelines. Four centers of the 54 (7%) reported no formal implementation efforts. Structural attention to the guidelines during daily clinical rounds was reported by 21 centers (38%). The most often reported reasons for non-adherence were "every patient is unique" and the presence of extracranial injuries, both for centers that did and did not report the use of guidelines.ConclusionsThere is substantial variability in the use and implementation of guidelines in neurotrauma centers in Europe. Further research is needed to strengthen the evidence underlying guidelines and to overcome implementation barriers.Copyright © 2019 Elsevier Inc. All rights reserved.

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