Evidence-based Guidelines for TBI “Didn’t Have Better Outcomes"
Written by Editor   
Thursday, July 30, 2015 10:10 AM

 In hospitals, following evidence-based guidelines for treating Traumatic Brain Injury does not ensure better outcomes.

Observations:   While evidence-based guidelines may improve individual outcomes, compliance with guidelines "doesn't tell you enough about the differences in the hospitals and how they practice care.”  Stated another way, doing the right thing does not guarantee that the right thing is done.

Potential actions: 

  • Bear in mind that evidence-based guidelines, like so many innovations in health care, are seldom a “holy grail” to perfect practice.

  • Let evidence-based guidelines “guide” and support your practice, not dictate it.


Hospitals that followed evidence-based guidelines for treating traumatic brain injuries (TBI) didn't have better outcomes for patients, suggesting that compliance with the guidelines is not necessary for genuinely high-quality TBI care, researchers asserted.

Researchers looked at hospital-level compliance with the Brain Trauma Foundation (BTF) guidelines for intracranial pressure (ICP) monitoring and craniotomies. They then compared the compliance rates with the rates of risk-adjusted mortality. The researchers found a wide variation in compliance rates across the 14 hospitals included in the study, however they did not find any correlation between metrics of guideline compliance and mortality rates. "We actually found no association whatsoever, meaning that hospitals that did more of what we think they should do didn't necessarily have better clinical outcomes for severe TBI," researchers added.

While the BTF guidelines may be evidence-based recommendations for optimal TBI treatment, adherence to these guidelines should not be used as a measure of hospital quality, researchers said. Guideline compliance alone "doesn't tell you enough about the differences in the hospitals and how they practice care," he said.

"This shouldn't be interpreted as a failure of the process-based quality metrics. At a patient level, there is often strong evidence that these processes of care improve patient outcomes. … The lack of association at the hospital level suggests that there are many factors that affect patient outcomes, and guideline adherence is just one small piece of the puzzle."

"Many factors affect patient outcomes in a hospital. Often we find that a provider's adherence to guidelines (or performance on process measures) is not highly predictive of these outcomes." 

Since the BTF first issued these guidelines in the early 90s, a 50% drop in death rate from severe TBI has occurred.

Source:  http://www.medpagetoday.com/Neurology/HeadTrauma/52744