Intensive Care Medicine

, Volume 27, Issue 2, pp 400-406

First online:

Intensive care management of head-injured patients in Europe: a survey from the European Brain Injury Consortium

  • Nino StocchettiAffiliated withTerapia Intensiva Neuroscienze, Serv. Anestesia e Rianimazione-Ospedale Policlinico IRCCS, Via Francesco Sforza 35, 20122 Milan, Italy
  • , Kay  I. PennyAffiliated withMedical Statistics Unit, University of Edinburgh Medical School, Edinburgh, UK
  • , Mark DeardenAffiliated withDepartment of Anaethetics, Leeds General Infirmary, Leeds, UK
  • , Reinder BraakmanAffiliated withBerkel Enschot, The Netherlands
  • , François CohadonAffiliated withDepartment of Neurosurgery, Hôpital Pellegrin, Bordeaux, France
  • , Fausto IannottiAffiliated withDepartment of Clinical Neurosciences, Southampton General Hospital, Southampton, UK
  • , Françoise LapierreAffiliated withCentre Hospitalier Universitaire de Poitiers, Service de Neurochirurgie, Poitiers, France
  • , Abbi KarimiAffiliated withNeurochirurgische Klinik, Universität Köln, Cologne, Germany
  • , Andrew MaasAffiliated withDepartment of Neurosurgery, University Hospital Rotterdam, Rotterdam, The Netherlands
    • , Gordon  D. MurrayAffiliated withMedical Statistics Unit, University of Edinburgh Medical School, Teviot Place, Edinburgh EH 89AG, UK
    • , Juha OhmanAffiliated withDepartment of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland
    • , Lennard PerssonAffiliated withDepartment of Neurosurgery, Akademiska Hospital, Uppsala, Sweden
    • , Franco ServadeiAffiliated withAzienda USL Cesena, Ospedale M. Bufalini, Cesena, Italy
    • , Graham  M. TeasdaleAffiliated withUniversity Department of Neurosurgery, Institute of Neurological Sciences, Southern General Hospital, Glasgow, UK
    • , Tomasz TrojanowskiAffiliated withDepartment of Neurosurgery, University Medical School, Lublin, Poland
    • , Andy Unterberg on behalf of the European Brain Injury ConsortiumAffiliated withDepartment of Neurosurgery, Virchow-Klilnikum, Medizinische Fakultät, Humboldt Universität Berlin, Berlin, Germany

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Objectives: (a) to describe current practice in the monitoring and treatment of moderate and severe head injuries in Europe; (b) to report on intracranial pressure and cerebral perfusion pressure monitoring, occurrence of measured and reported intracranial hypertension, and complications related to this monitoring; (c) to investigate the relationship between the severity of injury, the frequency of monitoring and management, and outcome. Methods: A three-page questionnaire comprising 60 items of information has been compiled by 67 centres in 12 European countries. Information was collected prospectively regarding all severe and moderate head injuries in adults (>16 years) admitted to neurosurgery within 24 h of injury. A total of 1005 adult head injury cases were enrolled in the study from 1 February 1995 to 30 April 1995. The Glasgow Outcome Scale was administered at 6 months. Results: Early surgery was performed in 346 cases (35%); arterial pressure was monitored invasively in 631 (68%), ICP in 346 (37%), and jugular bulb saturation in 173 (18%). Artificial ventilation was provided to 736 patients (78%). Intracranial hypertension was noted in 55% of patients in whom ICP was recorded, while it was suspected in only 12% of cases without ICP measurement. There were great differences in the use of ventilation and CPP monitoring among the centres. Mortality at 6 months was 31%. There was an association between an increased frequency of monitoring and intervention and an increased severity of injury; correspondingly, patients who more frequently underwent monitoring and ventilation had a less favourable outcome. Conclusions: In Europe there are great differences between centres in the frequency of CPP monitoring and ventilatory support applied to head-injured patients. ICP measurement disclosed a high rate of intracranial hypertension, which was not suspected in patients evaluated on a clinical basis alone. ICP monitoring was associated with a low rate of complications. Cases with severe neurological impairment, and with the worse outcome, were treated and monitored more intensively.

Head injury Intracranial pressure Cerebral perfusion pressure Artificial ventilation Outcome Intensive care