Clinical practice guidelines in severe traumatic brain injury in Taiwan

Kuo Hsing Liao, Cheng Kuei Chang, Hong Chang Chang, Kun Chuan Chang, Chieh Feng Chen, Tzu Yung Chen, Chi Wen Chou, Wen Yu Chung, Yung Hsiao Chiang, Kuo Sheng Hong, Sheng Huang Hsiao, Yu Hone Hsu, Hsu Lin Huang, Sheng Chien Huang, Ching Chang Hung, Sui Sum Kung, Ken Nan Kuo, Kun Hsing Li, Jia Wei Lin, Tzu Gan LinChien Min Lin, Chuan Fa Su, Ming Ta Tsai, Shin Han Tsai, Yu Chih Wang, Ta Yu Yang, Kuo Fan Yu, Wen Ta Chiu

Research output: Contribution to journalArticle

10 Citations (Scopus)


Background: Severe TBIs are major causes of disability and death in accidents. The Brain Trauma Foundation supported the first edition of the Guidelines for the Management of Severe Traumatic Brain Injury in 1995 and revised it in 2000. The recommendations in these guidelines are well accepted in the world. There are still some different views on trauma mechanisms, pathogenesis, and managements in different areas. Individualized guidelines for different countries would be necessary, and Taiwan is no exception. Methods: In November 2005, we organized the severe TBI guidelines committee and selected 9 topics, including ER treatment, ICP monitoring, CPP, fluid therapy, use of sedatives, nutrition, intracranial hypertension, seizure prophylaxis, and second-tier therapy. We have since searched key questions in these topics on Medline. References are classified into 8 levels of evidence: 1++, 1+, 1-, 2++, 2+, 2-, 3, and 4 based on the criteria of the SIGN. Results: Recommendations are formed and graded as A, B, C, and D. Grade A means that at least one piece of evidence is rated as 1++, whereas grade B means inclusion of studies rated as 2++. Grade C means inclusion of references rated as 2+, and grade D means levels of evidence rated as 3 or 4. Overall, 42 recommendations are formed. Three of these are rated as grade A, 13 as grade B, 21 as grade C, and 5 as grade D. Conclusions: We have completed the first evidence-based, clinical practice guidelines for severe TBIs. It is hoped that the guidelines will provide concepts and recommendations to promote the quality of care for severe TBIs in Taiwan.

Original languageEnglish
JournalSurgical Neurology
Issue numberSUPPL. 2
Publication statusPublished - Dec 2009


  • Clinical practice guidelines
  • Evidence-based
  • Guidelines
  • Management
  • Severe
  • Taiwan
  • Traumatic brain injury

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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    Liao, K. H., Chang, C. K., Chang, H. C., Chang, K. C., Chen, C. F., Chen, T. Y., Chou, C. W., Chung, W. Y., Chiang, Y. H., Hong, K. S., Hsiao, S. H., Hsu, Y. H., Huang, H. L., Huang, S. C., Hung, C. C., Kung, S. S., Kuo, K. N., Li, K. H., Lin, J. W., ... Chiu, W. T. (2009). Clinical practice guidelines in severe traumatic brain injury in Taiwan. Surgical Neurology, 72(SUPPL. 2).