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Brief Summary

GUIDELINE TITLE

Guidelines for the management of severe traumatic brain injury. Deep vein thrombosis prophylaxis.

BIBLIOGRAPHIC SOURCE(S)

  • Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons. Guidelines for the management of severe traumatic brain injury. Deep vein thrombosis prophylaxis. J Neurotrauma 2007;24(Suppl 1):S32-S36. [14 references]

GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates previous versions: Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care. Guidelines for the management of severe traumatic brain injury: cerebral perfusion pressure. New York (NY): Brain Trauma Foundation, Inc.; 2003 Mar 14. 14 p.

Brain Trauma Foundation, Inc, American Association of Neurological Surgeons. Part 1: guidelines for the management of severe traumatic brain injury. New York (NY): Brain Trauma Foundation, Inc.; 2000. 165 p.

** REGULATORY ALERT **

FDA WARNING/REGULATORY ALERT

Note from the National Guideline Clearinghouse: This guideline references a drug(s) for which important revised regulatory and/or warning information has been released.

  • February 28, 2008, Heparin Sodium Injection: The U.S. Food and Drug Administration (FDA) informed the public that Baxter Healthcare Corporation has voluntarily recalled all of their multi-dose and single-use vials of heparin sodium for injection and their heparin lock flush solutions. Alternate heparin manufacturers are expected to be able to increase heparin production sufficiently to supply the U.S. market. There have been reports of serious adverse events including allergic or hypersensitivity-type reactions, with symptoms of oral swelling, nausea, vomiting, sweating, shortness of breath, and cases of severe hypotension.

BRIEF SUMMARY CONTENT

 ** REGULATORY ALERT **
 RECOMMENDATIONS
 EVIDENCE SUPPORTING THE RECOMMENDATIONS
 IDENTIFYING INFORMATION AND AVAILABILITY
 DISCLAIMER

 Go to the Complete Summary

RECOMMENDATIONS

MAJOR RECOMMENDATIONS

The grades of evidence (I-III) and levels of recommendations (I-III) are defined at the end of the "Major Recommendations" field.

Level I

There are insufficient data to support a Level I recommendation for this topic.

Level II

There are insufficient data to support Level II recommendation for this topic.

Level III

Graduated compression stockings or intermittent pneumatic compression (IPC) stockings are recommended, unless lower extremity injuries prevent their use. Use should be continued until patients are ambulatory.

Low molecular weight heparin (LMWH) or low dose unfractionated heparin should be used in combination with mechanical prophylaxis. However, there is an increased risk for expansion of intracranial hemorrhage.

There is insufficient evidence to support recommendations regarding the preferred agent, dose, or timing of pharmacologic prophylaxis for deep vein thrombosis (DVT).

Summary

Level III evidence supports the use of graduated compression or IPC stockings placed for DVT prophylaxis for patients with severe traumatic brain injury (TBI), unless lower extremity injuries prevent their use. Level III evidence supports the use of prophylaxis with low-dose heparin or LMWH for prevention of DVT in patients with severe TBI. However, no reliable data can support a recommendation regarding when it is safe to begin pharmacological prophylaxis. Moreover, no recommendations can be made regarding medication choice or optimal dosing regimen for patients with severe TBI, based on the current evidence.

Definitions:

Grades of Evidence

Class I - Good quality randomized controlled trial (RCT)

Class II - Moderate quality RCT, good quality cohort, good quality case-control, poor quality RCT

Class III - Moderate or poor quality cohort, moderate or poor case-control, case series, databases or registries

Levels of Recommendation

Levels of recommendation are Level I, II, and III, derived from Class I, II, and III evidence, respectively.

Level I - recommendations are based on the strongest evidence for effectiveness, and represent principles of patient management that reflect a high degree of clinical certainty.

Level II - recommendations reflect a moderate degree of clinical certainty.

Level III - recommendations for which the degree of clinical certainty is not established.

CLINICAL ALGORITHM(S)

None provided

EVIDENCE SUPPORTING THE RECOMMENDATIONS

TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of supporting evidence is identified and graded for each recommendation (see the "Major Recommendations" field).

IDENTIFYING INFORMATION AND AVAILABILITY

BIBLIOGRAPHIC SOURCE(S)

  • Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons. Guidelines for the management of severe traumatic brain injury. Deep vein thrombosis prophylaxis. J Neurotrauma 2007;24(Suppl 1):S32-S36. [14 references]

ADAPTATION

Not applicable: The guideline was not adapted from another source.

DATE RELEASED

2000 (revised 2007)

GUIDELINE DEVELOPER(S)

Brain Trauma Foundation - Disease Specific Society

SOURCE(S) OF FUNDING

Brain Trauma Foundation

GUIDELINE COMMITTEE

Not stated

COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Primary Authors: Susan Carson, MPH, Oregon Health & Science University; Cynthia Davis-O'Reilly, BSc, Brain Trauma Foundation Center for Guidelines Management; Pamela Drexel, Brain Trauma Foundation; Rochelle Fu, PhD, Oregon Health & Science University; Susan Norris, MD, MPH, MSc, Oregon Evidence-based Practice Center; Michelle Pappas, BA, Brain Trauma Foundation Center for Guidelines Management; Kimberly Peterson, MS, Oregon Health & Science University; Adair Prall, MD, South Denver Neurosurgery; Patricia Raksin, MD, Cook County Hospital

FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

ENDORSER(S)

Congress of Neurological Surgeons - Professional Association

GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates previous versions: Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, Joint Section on Neurotrauma and Critical Care. Guidelines for the management of severe traumatic brain injury: cerebral perfusion pressure. New York (NY): Brain Trauma Foundation, Inc.; 2003 Mar 14. 14 p.

Brain Trauma Foundation, Inc, American Association of Neurological Surgeons. Part 1: guidelines for the management of severe traumatic brain injury. New York (NY): Brain Trauma Foundation, Inc.; 2000. 165 p.

GUIDELINE AVAILABILITY

Electronic copies: Available in Portable Document Format (PDF) from the Brain Trauma Foundation Web site.

Print copies: Available from the Brain Trauma Foundation, 708 Third Avenue, New York, NY 10017, E-mail: info@braintrauma.org

AVAILABILITY OF COMPANION DOCUMENTS

None available

PATIENT RESOURCES

None available

NGC STATUS

This NGC summary was completed by ECRI Institute on August 14, 2007. The information was verified by the guideline developer on January 28, 2008. This summary was updated by ECRI Institute on March 14, 2008 following the updated FDA advisory on heparin sodium injection.

COPYRIGHT STATEMENT

This is a limited license granted to NGC, AHRQ and its agent only. It may not be assigned, sold, or otherwise transferred. BTF owns the copyright. For any other permission regarding the use of these guidelines, please contact the Brain Trauma Foundation.

DISCLAIMER

NGC DISCLAIMER

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Readers with questions regarding guideline content are directed to contact the guideline developer.


 

 

   
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