Not that long ago Dr Alan Garner described the process for developing Carebundles as part of trying to deliver the best care and measure it at the same time. Here’s the first of the follow-up posts: on TBI.
The isolated severe traumatic brain injury bundle
As a follow up to our blog about Carebundles and their general utility in Prehospital and Retrieval Medicine we thought we might go through each of the bundles that we are using in Sydney and discuss our rationale for why we included the items we did and the evidence base for them. We hope this process will provide us with some open peer review of our criteria across an international cohort of our colleagues which can only be good for us.
The first thing to note is simply a repeat of my previous post. It is hard to get good evidence in the space we work in and much of the data is extrapolated forward from in-hospital practice. Mere geography alone should not affect pathophysiology so this approach is biologically plausible but we acknowledge it is not ideal. To quote from the previous post:
“We then turned to the evidence based consensus guidelines, Cochrane reviews and good quality RCTs to define the Carebundle items. This is a sobering process as you realise just how few interventions there are that have good evidence to back them up. This is particularly true for prehospital care where we are often operating in an evidence free zone. In many cases we had no choice but to go with the consensus (or best guess as I like to call it). We decided that we would include intubation for unconscious trauma patients for example despite the evidence not being all that strong and in many cases contradictory.”
So let’s look at our bundle items for isolated severe head injury (GCS <9) and why we chose them:
Intubation and mechanical ventilation..