Picetti etal.World Journal ofWorld Journalof Emergency Surgery (2023)18:5https:/doi.org/10.1186s13017-022-00468-2Emergency SurgeryRESEARCHOpen AccessEarly management of isolated severeeck 1otraumatic brain injury patients in a hospitalwithout neurosurgical capabilities:a consensusand clinical recommendations of the WorldSociety of Emergency Surgery(WSES)Edoardo Picetti,Fausto Catena2,Fikri Abu-Zidan3,Luca Ansaloni,Rocco A.Armondas6,Miklosh Bala,Zsolt J.Balogh,Alessandro Bertuccio,Walt L.Biff10,Pierre Bouzat1,Andras Buki2,Davide Cerasti3,Randall M.Chesnut156,Giuseppe Citerio,Federico Coccolini,Raul Coimbra2,Carlo Coniglio21Enrico Fainardi,Deepak Gupta,Jennifer M.Gurney5,Gregory W.J.Hawrylux,Raimund Helbok27Peter J.A.Hutchinson,Corradolaccarino,Angelos Kolias3031,Ronald W.Maier3,Matthew J.Martin33Geert Meyfroidt34.35,David O.Okonkwo36,Frank Rasulo37,Sandro Rizoli38,Andres Rubiano39,Juan Sahuquillo0Valerie G.Sams1,Franco Servadei243,Deepak Sharma4,Lori Shutter5,Philip F.Stahe,Fabio S.Taccone7Andrew Udy Tommaso Zoerle.Vanni Agnolettis,Francesca Bravis,Belinda De Simone,Yoram KlugerCostanza Martinoss,Ernest E.Moore5,Massimo Sartelli57,Dieter Weber58 and Chiara Robba960AbstractBackground Severe traumatic brain-injured (TBl)patients should be primarily admitted to a hub trauma center(hos-pital with neurosurgical capabilities)to allow immediate delivery of appropriate care in a specialized environment.Sometimes,severe TBl patients are admitted to a spoke hospital (hospital without neurosurgical capabilities),andscarce data are available regarding the optimal management of severe isolated TBI patients who do not have immedi-ate access to neurosurgical care.Methods A multidisciplinary consensus panel composed of 41 physicians selected for their established clinicaland scientific expertise in the acute management of TBl patients with different specializations(anesthesia/intensivecare,neurocritical care,acute care surgery,neurosurgery and neuroradiology)was established.The consensus wasendorsed by the World Society of Emergency Surgery,and a modified Delphi approach was adopted.Results A total of 28 statements were proposed and discussed.Consensus was reached on 22 strong recommen-dations and 3 weak recommendations.In three cases,where consensus was not reached,no recommendation wasprovided.Conclusions This consensus provides practical recommendations to support clinician's decision making in themanagement of isolated severe TBl patients in centers without neurosurgical capabilities and during transfer to a hubcenter.Keywords Traumatic brain injury,Management,Transfer,Hub,SpokeBMCThe Author(s)2023.Open AccessThis artidle is licensed undera Creative Commons Attribution 40 Intemnational License,whichpermits use,sharing adaptation,distribution and repoducton in any medium orfomat as long as you give appropriateceditto theofiginal author(s)and the source,provide a link to theCeative Commons licence,and indicate if changes wee made.The images orther third party m
