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Measuring the Quality of Care for Patients With Traumatic Brain Injury

Yaseen Arabi, MD, FCCP1; Sami Alsolamy, MD, MPH1; Saad Al-Qahtani, MD, MMEd, MAHA, FRCPC1
[+] Author Affiliations
1King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
JAMA Surg. 2016;151(3):294-295. doi:10.1001/jamasurg.2015.4227.
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To the Editor Dawes et al1 found no association of hospital-level compliance with the Brain Trauma Foundation (BTF) guidelines for intracranial pressure (ICP) monitoring and craniotomy with mortality rates for patients with severe traumatic brain injury (TBI). They concluded that evidence-based guidelines have a minimal association with outcomes for patients with severe TBI and suggested that caution should be taken before using compliance with these measures as independent quality metrics.1 However, it is unclear why the investigators selected only the 2 variables and why they did not examine adherence with other BTF guidelines for preventing secondary brain injury by management of blood pressure, oxygenation, and temperature, which may have a better evidence base. We have shown that an intensive care management protocol based on the BTF clinical practice guidelines was associated with a reduction in hospital mortality.2 However, we found that placement of an ICP monitor was not.2

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March 1, 2016
Xiulu Ruan, MD; Alan D. Kaye, MD, PhD
1Department of Anesthesiology, Louisiana State University Health Science Center, New Orleans
JAMA Surg. 2016;151(3):293-294. doi:10.1001/jamasurg.2015.4224.
March 1, 2016
Aaron J. Dawes, MD; H. Gill Cryer, MD, PhD
1Ronald Reagan UCLA (University of California, Los Angeles) Medical Center, Department of Surgery, David Geffen School of Medicine, UCLA, Los Angeles2Veterans Affairs/Robert Wood Johnson Foundation Clinical Scholars Program, UCLA, Los Angeles, California3Department of Health Policy and Management, Fielding UCLA School of Public Health, Los Angeles, California
1Ronald Reagan UCLA (University of California, Los Angeles) Medical Center, Department of Surgery, David Geffen School of Medicine, UCLA, Los Angeles
JAMA Surg. 2016;151(3):295. doi:10.1001/jamasurg.2015.4230.
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