Traumatic Brain Injuries (TBIs) pose a significant global health burden, with high mortality and long-term disability rates. This retrospective cohort study investigates the implementation and impact of the Brain Trauma Foundation (BTF) guidelines on TBI management in a Saudi Arabian tertiary care center. Data from the pre-implementation (2012) and post-implementation (2022) of BTF guidelines periods were compared. The patient demographics, injury severity, guideline adherence, and outcomes were analyzed. The results revealed a 33% increase in severe TBI cases from 2012 to 2022, possibly due to the development of a well-established trauma system designed to manage such cases. More importantly, implementing the BTF guidelines led to a marked improvement in patient outcomes. Compliance with guidelines, including the avoidance of hypoxia and hypotension, hyperosmolar therapy, and DVT prophylaxis significantly increased post-implementation. Mortality rates decreased from 45.4% to 14.2%, accompanied by a reduction in the intensive care unit (ICU) length of stay and an increase in the hospital length of stay. A comparison with international trauma centers highlights the importance of protocol-based management in improving the TBI outcomes and reducing the mortality—factors such as specialist-led care, institutional policies, and increased resources influenced guideline adherence and patient care. This study underscores the critical role of evidence-based guidelines in optimizing TBI management and emphasizes the need for their widespread implementation in clinical practice. In conclusion, this study demonstrates the substantial impact of BTF guidelines on enhancing TBI patient outcomes in a Saudi Arabian tertiary care center. The implementation of these guidelines resulted in a significant reduction in mortality and in an improved adherence to the best practices in TBI management, highlighting the importance of evidence-based protocols in optimizing patient care and outcomes.

Background: Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) causes severe postoperative pain; thoracic epidural analgesia is recommended, but the optimal epidural bupivacaine concentration has not been studied in this setting. We compared 0.25% and 0.125% epidural bupivacaine after CRS + HIPEC. Methodology: This retrospective cohort study included 77 adults who underwent CRS + HIPEC at a tertiary care center between January 2017 and December 2021. All received epidural fentanyl 2 mcg/ml with 0.125% (n = 59) or 0.25% (n = 18) bupivacaine (non-randomized). Pain severity was categorized from visual analog scale assessments. Secondary outcomes were sensory block level, supplementary intravenous (IV) analgesia, patient-controlled analgesia (PCA), and adverse effects. Groups were compared using Fisher’s exact or Fisher–Freeman–Halton exact tests. Results: Mild pain occurred in 11/18 patients (61.1%) receiving 0.25% and 19/59 (32.2%) receiving 0.125% bupivacaine (exploratory risk difference 28.9 percentage points; 95% confidence interval 3.1–50.3), moderate pain in 7 (38.9%) and 38 (64.4%), and severe pain in 0 and 2 (3.4%), respectively. The overall pain-severity distribution did not differ significantly (p = 0.101), nor did sensory block level (p = 0.284), supplementary IV analgesia (p = 0.272), PCA use (p = 1.000), or nausea and vomiting (p = 0.556). No patient had pruritus ormotor complications. Conclusion: No statistically significant differences in pain outcomes or adverse effects were detected between the two concentrations. The small, unequal, and non-randomized groups preclude conclusions about equivalence or superiority; adequately powered prospective studies are needed.