• Renato Fedatto Beraldo, Marcelo Charles Pereira, Bruno Liebl, Kanwaljeet Garg, Harsh Deora, Tessa A Harland, Bhavya Pahwa, Paulo Victor de Souza Araújo, Pedro Afonso Pereira Silvestre, Henrique Weiler CeccatoGuilhermeGDepartment of Neurosurgery, Mackenzie Evangelical University Hospital, Curitiba, Paraná, Brazil., Guilherme Santos Piedade, Zeferino Demartini, and Bipin Chaurasia.
• Department of Neurosurgery, Catholic Pontificate University of Paraná, Curitiba, Paraná, Brazil.
• World Neurosurg. 2025 Jan 28; 194: 123608123608.

BackgroundTraumatic brain injury management guidelines vary across regions and there is limited research on real-world adherence to these guidelines. We conducted a global survey to assess the adherence of neurosurgeons to traumatic brain injury guidelines and evidence-based medicine (EBM).MethodsA 24-item survey was created using Google Forms, covering demographic information, neurotrauma training, basic knowledge of EBM, and surgical and in-hospital management.ResultsResponses were collected from 233 neurosurgeons across 53 different countries. Approximately 45% of respondents reported not staying up to date with Brain Trauma Foundation guidelines, and 48% indicated a preference for relying on their own experience over EBM guidelines. Neurosurgeons from Asia and Africa were more likely to rely on personal experience, while those from Europe and North/Central and South America leaned toward EBM (P = 0.021). Additionally, 56% of respondents reported that their neurotrauma management at least sometimes diverged from recommended guidelines. Specifically, 58% never or rarely managed epidural hematoma of 30 cm³ conservatively, and 45% sometimes, often, or always treated subdural hematomas conservatively, even when EBM recommended surgery. Moreover, 24% at least sometimes managed patients conservatively despite a Glasgow Coma Scale score of less than 9 or a decrease of 2 or more points. In cerebellar hematomas, 46% sometimes opted for external ventricular drainage alone.ConclusionsNeurosurgeons from Europe and North/Central and South America tend to follow EBM guidelines more closely, while those from Asia and Africa often favor individual decision-making approaches.Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.

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