Clinical practice guidelines in severe traumatic brain injury in Taiwan

ArticleinSurgical Neurology 72 Suppl 2:S66-73; discussion S73-4 · October 2009with12 Reads
Impact Factor: 1.67 · DOI: 10.1016/j.surneu.2009.07.004 · Source: PubMed
Abstract

Severe TBIs are major causes of disability and death in accidents. The Brain Trauma Foundation supported the first edition of the Guidelines for the Management of Severe Traumatic Brain Injury in 1995 and revised it in 2000. The recommendations in these guidelines are well accepted in the world. There are still some different views on trauma mechanisms, pathogenesis, and managements in different areas. Individualized guidelines for different countries would be necessary, and Taiwan is no exception. In November 2005, we organized the severe TBI guidelines committee and selected 9 topics, including ER treatment, ICP monitoring, CPP, fluid therapy, use of sedatives, nutrition, intracranial hypertension, seizure prophylaxis, and second-tier therapy. We have since searched key questions in these topics on Medline. References are classified into 8 levels of evidence: 1++, 1+, 1-, 2++, 2+, 2-, 3, and 4 based on the criteria of the SIGN. Recommendations are formed and graded as A, B, C, and D. Grade A means that at least one piece of evidence is rated as 1++, whereas grade B means inclusion of studies rated as 2++. Grade C means inclusion of references rated as 2+, and grade D means levels of evidence rated as 3 or 4. Overall, 42 recommendations are formed. Three of these are rated as grade A, 13 as grade B, 21 as grade C, and 5 as grade D. We have completed the first evidence-based, clinical practice guidelines for severe TBIs. It is hoped that the guidelines will provide concepts and recommendations to promote the quality of care for severe TBIs in Taiwan.

    • "[82] Diagnosis of BA had been revolutionized greatly due to advanced MR technology, making easier to distinguish between the differential diagnosis of BA, like can do diffusion‑weighted imaging (DWI), which usually shows restricted diffusion (bright signal) that helps to differentiate abscesses from necrotic neoplasms, which are not usually restricted, although not all abscesses follow this rule. [83,84] Proton MR spectroscopy (1H‑MRS) is also a safe, noninvasive imaging modality and can accurately differentiate between necrotic/cystic tumor and cerebral abscesses. [85] DWI has a high sensitivity and specificity, over 90%, for discriminating epidermoid, which has low apparent diffusion coefficient (ADC) from arachnoid cyst (high ADC) and distinguishing abscess (low ADC) from necrotic tumor (high ADC) (1). "
    [Show abstract] [Hide abstract] ABSTRACT: Brain abscess (BA) is defined as a focal infection within the brain parenchyma, which starts as a localized area of cerebritis, which is subsequently converted into a collection of pus within a well-vascularized capsule. BA must be differentiated from parameningeal infections, including epidural abscess and subdural empyema. The BA is a challenge for the neurosurgeon because it is needed good clinical, pharmacological, and surgical skills for providing good clinical outcomes and prognosis to BA patients. Considered an infrequent brain infection, BA could be a devastator entity that easily left the patient into dead. The aim of this work is to review the current concepts regarding epidemiology, pathophysiology, etiology, clinical presentation, diagnosis, and management of BA.
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