Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury: A survey in 66 neurotrauma centers participating in the CENTER-TBI

Background: No definitive evidence exists on how intracranial hypertension should be treated in patients with traumatic brain injury (TBI). It is therefore likely that centers and practitioners individually balance potential benefits and risks of different intracranial pressure (ICP) management strategies, resulting in practice variation. The aim of this study was to examine variation in monitoring and treatment policies for intracranial hypertension in patients with TBI. Methods: A 29-item survey on ICP monitoring and treatment was developed based on literature and expert opinion, and pilot-tested in 16 centers. The questionnaire was sent to 68 neurotrauma centers participating in the Collaborative European Neurotrauma Effectiveness Research (CENTER-TBI) study. Results: The survey was completed by 66 centers (97% response rate). Centers were mainly academic hospitals (n = 60, 91%) and designated level I trauma centers (n = 44, 67%). The Brain Trauma Foundation guidelines were used in 49 (74%) centers. Approximately ninety percent of the participants (n = 58) indicated placing an ICP monitor in patients with severe TBI and computed tomography abnormalities. There was no consensus on other indications or on peri-insertion precautions. We found wide variation in the use of first- and second-tier treatments for elevated ICP. Approximately half of the centers were classified as having a relatively aggressive approach to ICP monitoring and treatment (n = 32, 48%), whereas the others were considered more conservative (n = 34, 52%). Conclusions: Substantial variation was found regarding monitoring and treatment policies in patients with traumatic brain injury and intracranial hypertension. The results of this survey indicate a lack of consensus between European neurotrauma centers and provide an opportunity and necessity for comparative effectiveness research

Towards operational satellite based atmospheric monitoring in Norway SatMoNAir.

The SatMoNAir project [NSC contract nr. JOP.12.12.2] builds on a previous NRS 'følgemiddel'-project, called `Roadmap towards EarthCARE and Sentinel 5 precursor', within which NILU and met.no developed a strategy for how best to prepare themselves for future European satellite missions for measuring atmospheric composition, with respect to their national monitoring, weather predictions and research tasks. Three specific topics were considered particularly relevant: a. Aerosols ¿Climate effects in Scandinavia and polar regions: analysis of episodes with high aerosol loads for Klif reporting, b. the Use of satellite based ozone measurements in national reporting, and c. Satellite based Air Quality monitoring of remote areas for EMEP reporting. Results from the work performed are described in this report. The outcomes of the project have been utilized in support of the National monitoring of greenhouse gases and aerosols (see Myhre et al., 2012), the atmospheric ozone layer (see Svendby et al., 2012), and have been reported to EMEP