POPULATION OF INTEREST

- All patients with a diagnosis of traumatic brain injury and an initial GCS of 3-8.
- All patients who receive a cranial procedure (ICP monitor, craniectomy, craniotomy).

INTENT (EXPECTED OUTCOMES)

- All patients in population of interest avoid hypotension and hypoxia: SBP never < 110 mmHg, MAP never < 60mmHg, SaO2 never < 93%.
- All patients in population of interest have PaCO2 monitored at every role of care; PaCO2 should not be >45mmHg or <35mmHg.
- All patients in population of interest have a head CT performed within 4 hours of injury and surgical intervention (if necessary) within 5 hours of injury.
- All patients with a ventriculostomy have hourly documentation of ICP/CPP and ventriculostomy output.
- All patients in population of interest who are unable to be monitored clinically (e.g., unable to hold sedation for Q1 hour neuro exam) have an ICP monitor or ventriculostomy placed prior to transport out of theater.

PERFORMANCE/ADHERENCE METRICS

- Number and percentage of patients in the population of interest with lowest SBP<110 within first 3 days after injury.
- Number and percentage of patients in the population of interest with MAP<60 within first 3 days after injury.
- Number and percentage of patients in the population of interest with SaO2<93% within first 3 days after injury.
- Number and percentage of patients in population of interest who have PaCO2 documented at every role of care (POI, POI MEDEVAC, Role 2-4, interfacility MEDEVAC).
- Number and percentage of patients in the population of interest who maintain PaCO2=35-45mmHg.
- Number and percentage of patients who had a head CT performed within 4 hours of injury.
- Number and percentage of patients who had a craniectomy performed within 5 hours of injury.
- Number and percentage of patients with a ventriculostomy who had hourly documentation of ICP/CPP and ventriculostomy output.
- Number and percentage of patients in the population of interest unable to be monitored clinically (e.g., unable to hold sedation for Q1 hour neuro exam) who have an ICP monitor or ventriculostomy placed prior to transport out of theater.

DATA SOURCE

- Patient Record
- DoDTR
- ICU flow sheet
- Neurologic assessment flow sheet

SYSTEM REPORTING & FREQUENCY

The above constitutes the minimum criteria for PI monitoring of this CPG. System reporting will be performed annually; additional PI monitoring and system reporting may be performed as needed.

The system review and data analysis will be performed by the JTS Chief and the JTS PI team.

RESPONSIBILITIES

It is the trauma team leader’s responsibility to ensure familiarity, appropriate compliance, and PI monitoring at the local level with this CPG.