Management of traumatic brain injury in adult—A cross-sectional national study

Background: Mild traumatic brain injury (mTBI) is a common cause for seeking care. Previous studies have shown considerable variations in TBI management. New guidelines may have influenced management routines. Methods: This is a descriptive cross-sectional study, collecting data through structured questionnaires. All Swedish emergency hospitals that manage and treat adult patients with mTBI (Reaction Level Scale [RLS] 1–3, Glasgow Coma Scale [GCS] 13–15, age > 18 years) for the initial 24 h after injury were included in this study. Results: The response rate among hospitals fulfilling the study criteria's was 61/67 (91%). We observed a distinct predominance of nonspecialists being responsible for the initial management of these patients, with general surgeons and ED-physicians being the dominating specialties. A total of 45/61 (74%) of the hospitals use a guideline when managing TBI, with 12 hospitals (20%) stating that no guideline was used. Conclusion: In general, established guidelines are used for the management of TBI in Sweden. However, some of these are outdated and several hospitals used local guidelines not based upon reliable evidence-based methodology. Most patients with TBI are managed by nonspecialist doctors, stressing the need of a reliable guideline.