Verification of guideline usage for severe brain injury by the Japan Society of Neurotraumatology (JSNT)

Abstract

A guideline for severe brain injury was published by The Japan Society of Neurotraumatology (JSNT) in 2000. The Guideline Committee verified the usage of the guideline by distributing a questionnaire to member institutes from 2003 to 2004. Subject: Institutions to which the representative members of The Japan Society of Neurotraumatology (JSNT) belong. Answering rate: 94% (46 out of 49 institutions), Description of the institutions: (1) 96% of the institutions have a neurosurgical intensive care unit (ICU). (2) Annual numbers of patients with head injury: 34% of the institutions have over 40 head injury patients, 39% have from 39 to 10, and 7% have less than 10, (3) Number of neurosurgeons who belong exclusively to ICU: 9% of the institutions have over 4 neurosurgeons, 13% have 3, 13% have 2, 20% have 1, and 44% have none. Result of questionnaire: (1) 39% of the institutions have management protocol and follow the guideline 20% refer to the guideline. 2% have an original protocol. 39% do not have a management protocol. (2) Rate of ICP monitoring of severe head injury patients: 43% of the institutions perform ICP monitoring for over 50% of head injury patients, 39% perform monitoring for less than 49% of the patients, and 17% do not perform monitoring. (3) Number of doctors and nurses who utilize the guideline in daily management: 83% of neurosurgeons and 22% of nurses. Recommendations: (1) To revise the guideline from a literature-based or consensus-based guideline to an evidence-based guideline. (2) To make it applicable for children and the elderly. (3) To make it applicable for managing multiple injuries including pre-hospital care.