New guidelines for the management of severe TBI provide an update of all available evidence and recommendations since the third edition of the guidelines was published in 2007, researchers reported — but, sadly, it lacks answers to many key clinical questions. A total of 189 publications provided evidence to support 28 recommendations on 18 topics in Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition,Nancy Carney, PhD, of Oregon Health and Science University in Portland, and colleagues reported online in Neurosurgery.
Despite major developments in the management of severe TBI, however, the guidelines do not include recommendations in many key areas because of a lack of evidence. As a result, the guidelines should not be considered a complete protocol for clinical use, the authors said. “Protocols specific to individual clinical environments need to be developed to fill the gaps in evidence-based recommendations,” Carney told MedPage Today. “Clinicians need to call upon their practical experience in the context of their particular environment to derive complete protocols.”