Observational studyIntensive care medicine2025
Staircase strategy, tier-three therapies, and effects on outcome in traumatic brain injured patients: the Triple-T TBI study.
Observational study in Intensive care medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
7 citing papers in PubMed.
- Efficacy and Predictors of Success of External Ventricular Drainage for the Management of Traumatic Intracranial Hypertension: A Retrospective Multicenter Cohort Study.Neurocritical care · 2026Article
- Non-invasive intracranial pressure estimation in the intensive care unit: narrative review of methods and clinical applications.Intensive care medicine · 2026Review
- A scoping review on the essential role of global neurotrauma in achieving the sustainable development goals.Discover public health · 2026Review
- Article
- Reappraising the bifrontal decompressive craniectomy: A systematic literature review of indications, outcomes, and clinical applications.Surgical neurology international · 2026Review
- Restoration of Enzymatic Activity of Energy-Related Proteins in Rats with Traumatic Brain Injury Following Administration of Gamma-Glutamylcysteine Ethyl Ester.Brain sciences · 2025Article
- Practical and theoretical perspectives on early decompressive craniectomy for traumatic brain injury. Authors' reply.Intensive care medicine · 2025Article
Corrections and comments
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Authors and funding
18 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo evaluate the clinical practice and timing of use of tier-three therapies (TTT) after traumatic brain injury (TBI), and to explore their association with intensive care unit (ICU) mortality and 3 months neurological outcome.
methodsInternational multicenter, retrospective, observational, cohort study performed in 16 ICUs including 408 adult TBI patients requiring at least one of the TTT [i.e. metabolic suppression with barbiturates, secondary decompressive craniectomy (DC), and mild hypothermia] for the control of intracranial hypertension during the ICU stay.
resultsAmong 408 adult TBI patients, secondary DC was the most frequent TTT utilized (n = 297, 72.8%), and was associated with reduced ICU mortality [Odds Ratio, OR 0.34 (95% Confidence Interval, CI 0.14-0.78) p = 0.012] and better neurological outcome (p = 0.047), whereas barbiturates were associated with increased ICU mortality [OR: 3.05 (95% CI 1.43-6.49); p = 0.004) and worse neurological outcome (p = 0.032). Two hundred and twenty-four (55%) patients received interventions in adherence to guidelines, which was associated with a non-significant trend towards better outcomes.
conclusionsThe staircase approach before the use of TTT was not often utilized after severe TBI. Secondary DC was performed more often than other treatments and its use was associated with improved mortality and neurological outcome. The benefits of adherence to guidelines before TTT prescription should be further evaluated.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.