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Comment & Response
March 2016

Measuring the Quality of Care for Patients With Traumatic Brain Injury—Reply

Author Affiliations
  • 1Ronald Reagan UCLA (University of California, Los Angeles) Medical Center, Department of Surgery, David Geffen School of Medicine, UCLA, Los Angeles
  • 2Veterans Affairs/Robert Wood Johnson Foundation Clinical Scholars Program, UCLA, Los Angeles, California
  • 3Department of Health Policy and Management, Fielding UCLA School of Public Health, Los Angeles, California
JAMA Surg. 2016;151(3):295. doi:10.1001/jamasurg.2015.4230

In Reply We thank both sets of authors for their comments on our article.1 Arabi and colleagues pose several important questions about our methods, namely our choice of Brain Trauma Foundation guidelines. Only 1 of 15 clinical areas listed in the current Brain Trauma Foundation guidelines is supported by level I evidence (not using steroids); the remainder are supported by level II evidence, including intracranial pressure monitoring.2 Moreover, although intracranial pressure monitoring has fallen out of favor with some surgeons, other studies, including one from our consortium,3 continue to find a benefit for invasive monitoring, particularly for patients whose cerebral function is difficult to monitor clinically.

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