Clinical trials have shown that intravenous albumin and decompressive craniectomy to treat early refractory intracranial hypertension can cause harm in patients with severe traumatic brain injury (TBI). The extent to which these treatments remain in use is unknown. We conducted a multi-center retrospective cohort study of adult patients with severe TBI admitted to five neurotrauma centers across Australia between April 2013 and March 2015. Patients were identified from local trauma and intensive care unit (ICU) registries and followed until hospital discharge. Main outcome measures were the administration of intravenous albumin, and decompressive craniectomy for intracranial hypertension. Analyses were predominantly descriptive. There were 303 patients with severe TBI, of whom a minority received albumin (6.9%) or underwent early decompressive craniectomy for treatment of refractory intracranial hypertension complicating diffuse TBI (2.3%). The median (intequartile range [IQR]) age was 35 (24, 58), and most injuries were caused by road traffic accidents (57.4%) or falls (25.1%). Overall, 34.3% of patients died while in the hospital and the remainder were discharged to rehabilitation (44.6%), other health care facilities (4.6%), or home (16.5%). There were no patient characteristics significantly associated with use of albumin or craniectomy. Intravenous albumin and craniectomy for treatment of intracranial hypertension were used infrequently in Australian neurotrauma centers, indicating alignment between best available evidence and practice.

中文翻译：

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澳大利亚严重创伤性脑损伤患者的管理：是否仍在使用潜在有害的治疗方法？

临床试验表明，静脉注射白蛋白和去骨瓣减压术治疗早期难治性颅内高压可能对严重创伤性脑损伤（TBI）患者造成伤害。这些治疗的使用程度尚不清楚。我们对 2013 年 4 月至 2015 年 3 月期间在澳大利亚的五个神经创伤中心收治的严重 TBI 成年患者进行了一项多中心回顾性队列研究。患者是从当地创伤和重症监护病房 (ICU) 登记处确定的，并随访至出院。主要结局指标是静脉注射白蛋白和颅内高压去骨瓣减压术。分析主要是描述性的。有 303 名重度 TBI 患者，其中少数患者接受了白蛋白治疗（6. 9%) 或接受早期去骨瓣减压术治疗难治性颅内高压并发弥漫性 TBI (2.3%)。中位（四分位距 [IQR]）年龄为 35 岁（24、58），大多数伤害是由道路交通事故 (57.4%) 或跌倒 (25.1%) 造成的。总体而言，34.3% 的患者在住院期间死亡，其余患者出院接受康复治疗 (44.6%)、其他医疗机构 (4.6%) 或家中 (16.5%)。没有与使用白蛋白或开颅手术显着相关的患者特征。澳大利亚神经创伤中心很少使用静脉白蛋白和颅骨切除术治疗颅内高压，这表明最佳可用证据与实践之间存在一致性。中位（四分位距 [IQR]）年龄为 35 岁（24、58），大多数伤害是由道路交通事故 (57.4%) 或跌倒 (25.1%) 造成的。总体而言，34.3% 的患者在住院期间死亡，其余患者出院接受康复治疗 (44.6%)、其他医疗机构 (4.6%) 或家中 (16.5%)。没有与使用白蛋白或开颅手术显着相关的患者特征。澳大利亚神经创伤中心很少使用静脉白蛋白和颅骨切除术治疗颅内高压，这表明最佳可用证据与实践之间存在一致性。中位（四分位距 [IQR]）年龄为 35 岁（24、58），大多数伤害是由道路交通事故 (57.4%) 或跌倒 (25.1%) 造成的。总体而言，34.3% 的患者在住院期间死亡，其余患者出院康复 (44.6%)、其他医疗机构 (4.6%) 或家中 (16.5%)。没有与使用白蛋白或开颅手术显着相关的患者特征。澳大利亚神经创伤中心很少使用静脉白蛋白和颅骨切除术治疗颅内高压，这表明最佳可用证据与实践之间存在一致性。其他医疗保健机构 (4.6%) 或家庭 (16.5%)。没有与使用白蛋白或开颅手术显着相关的患者特征。澳大利亚神经创伤中心很少使用静脉白蛋白和颅骨切除术治疗颅内高压，这表明最佳可用证据与实践之间存在一致性。其他医疗保健机构 (4.6%) 或家庭 (16.5%)。没有与使用白蛋白或开颅手术显着相关的患者特征。澳大利亚神经创伤中心很少使用静脉白蛋白和颅骨切除术治疗颅内高压，这表明最佳可用证据与实践之间存在一致性。