Abstract When the fourth edition of the Brain Trauma Foundation's Guidelines for the Management of Severe Traumatic Brain Injury were finalized in late 2016, it was known that the results of the RESCUEicp (Trial of Decompressive Craniectomy for Traumatic Intracranial Hypertension) randomized controlled trial of decompressive craniectomy would be public after the guidelines were released. The guideline authors decided to proceed with publication but to update the decompressive craniectomy recommendations later in the spirit of “living guidelines,” whereby topics are updated more frequently, and between new editions, when important new evidence is published. The update to the decompressive craniectomy chapter presented here integrates the findings of the RESCUEicp study as well as the recently published 12-mo outcome data from the DECRA (Decompressive Craniectomy in Patients With Severe Traumatic Brain Injury) trial. Incorporation of these publications into the body of evidence led to the generation of 3 new level-IIA recommendations; a fourth previously presented level-IIA recommendation remains valid and has been restated. To increase the utility of the recommendations, we added a new section entitled Incorporating the Evidence into Practice. This summary of expert opinion provides important context and addresses key issues for practitioners, which are intended to help the clinician utilize the available evidence and these recommendations. The full guideline can be found at: https://braintrauma.org/guidelines/guidelines-for-the-management-of-severe-tbi-4th-ed#/.

中文翻译：

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严重创伤性脑损伤治疗指南：2020 年去骨瓣减压术建议更新


摘要 2016年底，脑外伤基金会第四版《严重外伤性脑损伤治疗指南》最终确定时，我们得知RESCUEicp（去骨瓣减压术治疗外伤性颅内高压的减压试验）随机对照试验的结果。指南发布后将向社会公开。指南作者决定继续出版，但稍后本着“生活指南”的精神更新去骨瓣减压术建议，即当重要的新证据发表时，主题会更频繁地更新，并且在新版本之间进行更新。这里介绍的去骨瓣减压术章节的更新整合了 RESCUEicp 研究的结果以及最近发布的 DECRA（严重创伤性脑损伤患者的去骨瓣减压术）试验的 12 个月结果数据。将这些出版物纳入证据体系后，产生了 3 项新的 IIA 级建议；先前提出的第四项 IIA 级建议仍然有效并已得到重述。为了提高建议的实用性，我们添加了一个名为“将证据纳入实践”的新部分。这份专家意见摘要为从业者提供了重要的背景并解决了关键问题，旨在帮助临床医生利用现有的证据和这些建议。完整指南可在以下网址找到：https://braintrauma.org/guidelines/guidelines-for-the-management-of-severe-tbi-4th-ed#/。