Do neurosurgeons follow the guidelines? A world-based survey on severe traumatic brain injury

Giorgio Saraceno, Franco Servadei, Lodovico Terzi DI Bergamo, Corrado Iaccarino, Andrés M Rubiano, Cesare Zoia, Giovanni Raffa, Gregory Hawryluk, André Grotenhuis, Andreas K Demetriades, Francesco Sala, Francesco Belotti, Luca Zanin, Francesco Doglietto, Pier Paolo Panciani, Antonio Biroli, Edoardo Agosti, Simona Serioli, Lukas Rasulic, Michaël BruneauIsabelle M Germano, Roman Bosnjak, Claudius Thomé, Luca Regli, Miroslav Vukic, Enrico Tessitore, Karl Schaller, Bipin Chaurasia, Nasser M El-Ghandour, Antonio DI Ieva, Daniele Bongetta, Ignazio Borghesi, Marco Fazio, Ignatius N Esene, Gail Rosseau, Najia El Abbadi, Matteo Baccanelli, Peter Vajkoczy, Marco M Fontanella

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


BACKGROUND: Traumatic brain injury (TBI) is going to be the third-leading cause of death worldwide, according to the WHO. Two European surveys suggested that adherence to brain trauma guidelines is poor. No study has compared compliance between low- (LMICs) and high-income (UHICs) countries. Hence, this study aimed to investigate differences in the management of severe TBI patients, comparing low- and high-income, and adherence to the BTF guidelines.

METHODS: A web-based survey was spread through the Global Neuro Foundation, different neurosurgical societies, and social media.

RESULTS: A total of 803 neurosurgeons participated: 70.4 from UHICs and 29.6% from LMICs. Hypertonic was administered as an early measure by the 73% and 65% of the responders in LMICs and UHICs, respectively (P=0.016). An invasive intracranial pressure monitoring was recommended by the 66% and 58% of the neurosurgeons in LMICs and UHICs, respectively (P<0.001). Antiseizure drugs (P<0.001) were given most frequently in LMICs as, against recommendations, steroids (87% vs. 61% and 86% vs. 81%, respectively). In the LMICs both the evacuation of the contusion and decompressive craniectomy were performed earlier than in UHICs (30% vs. 17% with P<0.001 and 44% vs. 28% with P=0.006, respectively). In the LMICs, the head CT control was performed mostly between 12 and 24 hours from the first imaging (38% vs. 23%, P<0.001).

CONCLUSIONS: The current Guidelines on TBI do not always fit to both the resources and circumstances in different countries. Future research and clinical practice guidelines should reflect the greater relevance of TBI in low resource settings.

Original languageEnglish
Pages (from-to)465-473
Number of pages9
JournalJournal of neurosurgical sciences
Issue number5
Publication statusPublished - Oct 2021

Bibliographical note

Publisher Copyright:
© 2021 Edizioni Minerva Medica.

Copyright 2021 Elsevier B.V., All rights reserved.


  • Brain Injuries, Traumatic/surgery
  • Humans
  • Neurosurgeons
  • Surveys and Questionnaires


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