{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,25]],"date-time":"2025-09-25T18:19:56Z","timestamp":1758824396159},"reference-count":18,"publisher":"Cambridge University Press (CUP)","issue":"3","license":[{"start":{"date-parts":[[2014,12,2]],"date-time":"2014-12-02T00:00:00Z","timestamp":1417478400000},"content-version":"unspecified","delay-in-days":2680,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Can. j. neurol. sci."],"published-print":{"date-parts":[[2007,8]]},"abstract":"<jats:sec id=\"S0317167100006727_abs1\"><jats:title>Objective:<\/jats:title><jats:p>To determine: 1. the degrees of consensus and disagreement among Canadian critical care clinicians regarding the appropriateness (benefit exceeding risk) of common therapeutic manoeuvres in patients with severe closed head injury (CHI), and 2. the frequency with which clinicians employed these manoeuvres.<\/jats:p><\/jats:sec><jats:sec id=\"S0317167100006727_abs2\"><jats:title>Methods:<\/jats:title><jats:p>The study design was a systematic scenario-based survey of all neurosurgeons and critical care physicians treating patients with severe CHI in Canada.<\/jats:p><\/jats:sec><jats:sec id=\"S0317167100006727_abs3\"><jats:title>Results:<\/jats:title><jats:p>In the scenario of acute epidural hematoma with mass effect, respondents agreed very strongly that surgery was appropriate. Clinicians reported mannitol and hypertonic saline as appropriate. Beyond these two interventions, agreement was less strong, and the use of the extraventricular drain (EVD), phenytoin, cooling, hyperventilation, nimodipine, and jugular venous oximetry (JVO) were of uncertain appropriateness. Steroids were considered inappropriate. In a scenario of diffuse axonal injury (DAI), clinicians agreed strongly that fever reduction, early enteral feeding, intensive glucose control, and cerebral perfusion pressure (CPP)-directed management were appropriate. The use of mannitol, hypertonic saline, EVD, JVO, narcotics and propofol were also appropriate. Neuromuscular blockade, surgery, and hyperventilation were of uncertain appropriateness. The appropriateness ratings of the interventions considered in the scenario of an intracranial contusion mirrored the DAI scenario. In general, correlations between the reported appropriateness and frequency of use of each intervention were very high. An exception noted was the use of the JVO. The correlation between CPP-guided therapy and the use of the EVD was weak.<\/jats:p><\/jats:sec><jats:sec id=\"S0317167100006727_abs4\"><jats:title>Conclusions:<\/jats:title><jats:p>This survey has described current practice with regard to treatment of patients with severe CHI. Areas of variation in perceived appropriateness were identified that may benefit from further evaluation. Suggested priorities for evaluation include the use of osmotic diuretics, anticonvulsants, and intracranial manometry.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0317167100006727","type":"journal-article","created":{"date-parts":[[2014,12,12]],"date-time":"2014-12-12T15:27:38Z","timestamp":1418398058000},"page":"307-312","source":"Crossref","is-referenced-by-count":13,"title":["Survey of Management of Severe Head Injury in Canada"],"prefix":"10.1017","volume":"34","author":[{"given":"Michael J.","family":"Jacka","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Zygun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2014,12,2]]},"reference":[{"key":"S0317167100006727_ref018","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa011300"},{"key":"S0317167100006727_ref013","doi-asserted-by":"publisher","DOI":"10.1097\/01.CCM.0000150269.65485.A6"},{"key":"S0317167100006727_ref006","doi-asserted-by":"publisher","DOI":"10.1136\/emj.2004.022673"},{"key":"S0317167100006727_ref011","first-page":"47","article-title":"Hyperventilation in traumatic brain injury patients: inconsistency between consensus guidelines and clinical practice","volume":"52","author":"Thomas","year":"2002","journal-title":"J Trauma"},{"key":"S0317167100006727_ref009","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocn.2005.02.002"},{"key":"S0317167100006727_ref010","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1016\/S0140-6736(04)17188-2","article-title":"Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH trial): randomised placebo-controlled trial","volume":"364","author":"Roberts","year":"2004","journal-title":"Lancet"},{"key":"S0317167100006727_ref012","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1991.75.5.0731"},{"key":"S0317167100006727_ref003","first-page":"306","article-title":"The management of traumatic brain injury: the development of guidelines and their influence","volume":"52","author":"Sekula","year":"2005","journal-title":"Clin Neurosurg"},{"key":"S0317167100006727_ref001","doi-asserted-by":"publisher","DOI":"10.1017\/S0317167100016930"},{"key":"S0317167100006727_ref004","first-page":"450","volume":"17","year":"2000","journal-title":"J Neurotrauma"},{"key":"S0317167100006727_ref005","doi-asserted-by":"publisher","DOI":"10.1097\/00003246-200208000-00033"},{"key":"S0317167100006727_ref014","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199702203360803"},{"key":"S0317167100006727_ref017","first-page":"CD001530","article-title":"Nutritional support for head-injured patients","volume":"4","author":"Perel","year":"2006","journal-title":"Cochrane Database Syst Rev"},{"key":"S0317167100006727_ref015","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200102223440803"},{"key":"S0317167100006727_ref002","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-1383(03)00028-7"},{"key":"S0317167100006727_ref007","doi-asserted-by":"publisher","DOI":"10.1007\/3-211-32318-X_91"},{"key":"S0317167100006727_ref008","doi-asserted-by":"publisher","DOI":"10.1007\/3-211-30714-1_77"},{"key":"S0317167100006727_ref016","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199008233230801"}],"container-title":["Canadian Journal of Neurological Sciences \/ Journal Canadien des Sciences Neurologiques"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0317167100006727","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,5,1]],"date-time":"2019-05-01T21:53:01Z","timestamp":1556747581000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0317167100006727\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2007,8]]},"references-count":18,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2007,8]]}},"alternative-id":["S0317167100006727"],"URL":"https:\/\/doi.org\/10.1017\/s0317167100006727","relation":{},"ISSN":["0317-1671","2057-0155"],"issn-type":[{"value":"0317-1671","type":"print"},{"value":"2057-0155","type":"electronic"}],"subject":[],"published":{"date-parts":[[2007,8]]}}}