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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
Arabi Y, Alsolamy S, Al-Qahtani S. Measuring the Quality of Care for Patients With Traumatic Brain Injury. JAMA Surg. 2016;151(3):294-295. doi:10.1001/jamasurg.2015.4227