The impact on outcomes in a community hospital setting of using the AANS traumatic brain injury guidelines

Background: Traumatic brain injury poses a serious public health challenge, Treatment paradigms have dramatically shifted with the introduction of the American Association of Neurologic Surgeons (AANS) Guidelines for the Mana gement of Severe Head Injury, Implementation of the AANS guidelines positiv ely affects patient outcomes and can be successfully introduced in a commun ity hospital setting. Methods: Data were collected both retrospectively and prospectively from th e records of all trauma patients between 1994 and 1999, A cohort of 93 pati ents was selected. Thirty-seven patients were treated before the implementa tion of the AANS guidelines, and these were statistically compared with 56 patients treated after the implementation of the guidelines. Results: Implementation of the recommendations in the AANS guidelines in a standardized protocol resulted in a 9.13 times higher odds ratio of a good outcome relative to the odds of a poor outcome or death compared with a gro up managed before the practice change. A Glasgow Coma Scale (GCS) admission score > 8 was associated with a 6.58 times higher odds ratio of a good out come compared with a GCS admission score less than or equal to 8, Odds rati o of a good outcome decreased by a factor of 0.92 for each year increase in age of patients starting at age 9, A dedicated neurotrauma team and compre hensive treatment algorithms are critical elements to this success. Hospita l charges increased by more than $97,000 per patient, but are justifiable i n the face of significantly improved outcomes. Conclusion: Implementation of a traumatic brain injury protocol in a commun ity hospital setting is practical and efficacious. Appropriate invasive mon itoring of systemic and cerebral parameters guides care decisions. The prot ocol results in an increase in resource usage, but it also results in stati stically improved outcomes justifying the increase in expenditures.