Trends in head injury outcome from 1989 to 2003 and the effect of neurosurgical care: an observational study

Standardizing Data Collection in Traumatic Brain Injury

“…Pooling data from multiple studies (individual patient data analysis), and comparative effectiveness research (CER) utilizing prospective observational data collection, can provide alternative sources of evidence that can be obtained in a more costefficient way. The direct relevance and potential of such approaches is illustrated by the results from the meta-analysis of individual patient data performed by the IMPACT study group, and by the fact that major advances in clinical care for TBI have resulted from previous observational studies, such as the U.S. Traumatic Coma Databank (Foulkes et al, 1991), the European Brain Injury Consortium (EBIC) Core Data Survey (Murray et al, 1999), The Vietnam Head Injury Study (Salazar et al, 1995), and the Trauma Audit And Research Network Registry (TARN; Patel et al, 2005). When undertaking high-quality observational data collection across multiple settings, or when analyzing individual patient data from various studies, standardization of data collection and coding is essential.…”

Conventional treatments for severe head injury: are they effective, ineffective, or even harmful?

“…Lack of improved outcome after head injury during the same period was also shown in a British study by Hyam et al (15). These results are interesting and worrying in view of the fact that the quality of both general intensive care and pre-hospital care has improved over the same period, resulting in a better outcome for trauma patients without severe head injury (14). Thus, it seems that the more protocol-driven guidelines introduced in the middle of the 1990s have not improved outcome.…”

“…A comprehensive analysis of trauma patients in England and Wales from 1989 to 2003 by Patel et al (14) showed that no improvement was observed for head-injured patients between 1995 and 2003. Lack of improved outcome after head injury during the same period was also shown in a British study by Hyam et al (15).…”

“…The lack of scientific support for the use of the most common therapeutic components and, considering the discouraging results from the outcome studies mentioned above (14,15), require careful considerations and an open mind regarding alternative approaches of severe head injury. New therapeutic components to be evaluated in clinical studies, for example, may be the use of low-dose steroid therapy to compensate for post-traumatic adrenal insufficiency in analogy to what has been recommended for sepsis (16), and reducing contusion bleedings by early strengthening of coagulation (17).…”

Trauma registries in Europe

“…Examples from existing trauma registries show that registry-based analyses are worth publishing, even in the highest-ranked medical journals [3,4].…”