Evidence summary for protocol-directed care

Study	Design	N	Population	Findings
Elf, 2002 [19]	Retrospective	154	TBI	Organized secondary insult management protocol and neurointensive care improved mortality rates and percentage of favorable outcome using GOS scores after 6 months
Patel, 2002 [20]	Retrospective	285	TBI	Patients with severe head injury treated by ICP/CPP targeted protocol and neurocritical care specialists had higher percentage of favorable outcome measured by GOS scores 6 months post-injury
Arabi, 2010 [40]	Retrospective/prospective	434	TBI	Implementation of protocol management based on BTF guidelines was associated with reduction in hospital and ICU mortality
Eker, 1998 [41]	Prospective	91	TBI	Protocol targeting brain volume regulation and microcirculation reduced mortality and improved percentage of favorable outcome measured by GOS 6 months post-injury
McKinley, 1999 [42]	Retrospective/prospective	24	TBI	ICP management protocol resulted in more consistent and improved ICP control, and less variation in CPP
Vukic, 1999 [43]	Retrospective	39	TBI	Protocol based on BTF guidelines for ICP management resulted in decreased mortality and improved percentage of favorable GOS scale scores
McIlvoy, 2001 [44]	Retrospective/prospective	125	TBI	BTF guidelines used to develop 4-phase protocol for ICP/CPP management, resulting in decreased hospital and ICU length of stay, decreased number of ventilator days and incidence of pneumonia, and earlier tracheostomy
Palmer, 2001 [45]	Retrospective/prospective	93	TBI	BTF guideline implementation improved odds of good outcome, measured by GOS at 6 months
Vitaz, 2001 [46]	Retrospective/prospective	162	TBI	Standardized clinical pathway for ICP/CPP management resulted in decreased hospital and unit length of stay and decreased ventilator days
Clayton, 2004 [47]	Retrospective	669	TBI	CPP management protocol decreased ICU and hospital mortality, but had no effect on length of stay
Fakhry, 2004 [48]	Retrospective/prospective	830	TBI	Protocol developed from BTF guidelines decreased hospital length of stay and costs, and demonstrated a decreased trend in mortality and improved functional recovery
Cremer, 2005 [49]	Retrospective/prospective	333	TBI	ICP/CPP targeted algorithm resulted in increased number of ventilator days and therapy intensity, with no difference in mortality when compared to supportive care control group
Talving, 2013 [50]	Prospective	216	TBI	Observational study comparing patients managed with ICP monitoring versus no monitoring and compliance with BTF guidelines. In hospital mortality higher in patients with no ICP monitoring. ICP monitoring group had longer ICU and hospital length of stay. BTF guideline compliance was 46.8 %
Biersteker, 2012 [51]	Observational multi-site	265	TBI	Investigated compliance and outcomes of BTF guidelines for ICP monitoring. Guideline compliance was 46 %. Guideline compliance was not associated with mortality or unfavorable outcome when controlling for baseline and clinical characteristics
Meretoja, 2010 [52]	Observational, multi-registry	61,685	AIS	Compared data from 333 hospitals classified as comprehensive stroke centers, primary stroke centers, and general hospitals. Mortality rates lower in stroke centers for up to 9 years
Smith, 2010 [53]	Longitudinal cohort registry	6,223	AIS	Organized stroke care resulted in decreased 30 day mortality for each ischemic stroke subtype
Schwamm, 2009 [54]	Prospective quality initiative	322, 847	AIS, TIA	Centers that participated in Get with the Guidelines-Stroke reported higher compliance with all stroke performance measures
Gropen, 2006 [55]	Retrospective quality initiative	1,442	AIS	Designated stroke centers utilizing Brain Attack Coalition guidelines experienced shorter door to MD contact, CT scan time, and t-PA administration time.