Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis

Huijben, Jilske A.; Wiegers, Eveline J. A.; Lingsma, Hester F.; Citerio, Giuseppe; Maas, Andrew I. R.; Menon, David K.; Ercole, Ari; Nelson, David; van der Jagt, Mathieu; Steyerberg, Ewout W.; Helbok, Raimund; Lecky, Fiona; Peul, Wilco; Birg, Tatiana; Zoerle, Tommaso; Carbonara, Marco; Stocchetti, Nino; Åkerlund, Cecilia; Amrein, Krisztina; Andelic, Nada; Andreassen, Lasse; Audibert, Gérard B.; Azouvi, Philippe; Azzolini, Maria Luisa; Bartels, R.; Beer, R.; Bellander, B.-M.; Benali, H.; Berardino, M.; Beretta, L.; Beqiri, E.; Blaabjerg, M.; Lund, S. B.; Brorsson, C.; Buki, A.; Cabeleira, M.; Caccioppola, A.; Calappi, E.; Calvi, M. R.; Cameron, P.; Lozano, G. C.; Castaño-León, A. M.; Cavallo, S.; Chevallard, G.; Chieregato, A.; Coburn, M.; Coles, J.; Cooper, J. D.; Correia, M.; Czeiter, E.; Czosnyka, M.; Dahyot-Fizelier, C.; Dark, P.; De Keyser, Véronique; Degos, V.; Della Corte, F.; den Boogert, H.; Depreitere, B.; Dilvesi, D.; Dixit, A.; Dreier, J.; Dulière, Guy-Loup; Ezer, E.; Fabricius, M.; Foks, K.; Frisvold, S.; Furmanov, A.; Galanaud, D.; Gantner, D.; Ghuysen, Alexandre; Giga, L.; Golubovic, J.; Gomez, P. A.; Grossi, F.; Gupta, D.; Haitsma, I.; Helseth, E.; Hutchinson, P. J.; Jankowski, S.; Johnson, F.; Karan, M.; Kolias, A. G.; Kondziella, D.; Koraropoulos, E.; Koskinen, L.-O.; Kovács, N.; Kowark, A.; Lagares, A.; Laureys, Steven; LEDOUX, Didier; Lejeune, Aurélie; Lightfoot, R.; Manara, A.; Martino, C.; Maréchal, H.; Mattern, J.; McMahon, C.; Menovsky, T.; Misset, Benoît; Muraleedharan, V.; Murray, L.; Negru, A.; Newcombe, V.; Nyirádi, J.; Ortolano, F.; Payen, J.-F.; Perlbarg, V.; Persona, P.; Piippo-Karjalainen, A.; Ples, H.; Pomposo, I.; Posti, J. P.; Puybasset, L.; Radoi, A.; Ragauskas, A.; Raj, R.; Rhodes, J.; Richter, S.; Rocka, S.; Roe, C.; Roise, O.; Rosenfeld, J. V.; Rosenlund, C.; Rosenthal, G.; Rossaint, R.; Rossi, S.; Sahuquillo, J.; Sandrød, O.; Sakowitz, O.; Sanchez-Porras, R.; Schirmer-Mikalsen, K.; Schou, R. F.; Smielewski, P.; Sorinola, A.; Stamatakis, E.; Sundström, N.; Takala, R.; Tamás, V.; Tamosuitis, T.; Tenovuo, O.; Thomas, M.; Tibboel, D.; Tolias, C.; Trapani, T.; Tudora, C. M.; Vajkoczy, P.; Vallance, S.; Valeinis, E.; Vámos, Z.; Van der Steen, G.; van Wijk, R. P. J.; Vargiolu, A.; Vega, E.; Vik, A.; Vilcinis, R.; Volovici, V.; Vulekovic, P.; Williams, G.; Winzeck, S.; Wolf, S.; Younsi, A.; Zeiler, F. A.; Clusmann, A. Z. H.; Voormolen, D.; van Dijck, J. T. J. M.; van Essen, T. A.; CENTER-TBI investigators and participants

doi:10.1007/s00134-020-05965-z

Article (Scientific journals)

Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis

Huijben, Jilske A.; Wiegers, Eveline J. A.; Lingsma, Hester F. et al.

2020 • In Intensive Care Medicine, 46 (5), p. 995-1004

Peer Reviewed verified by ORBi

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https://hdl.handle.net/2268/249924

DOI
10.1007/s00134-020-05965-z

PubMed
32100061

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Keywords :

Intensive care unit; Intracranial pressure; Outcome; Traumatic brain injury

Abstract :

[en] Purpose: To describe ICU stay, selected management aspects, and outcome of Intensive Care Unit (ICU) patients with traumatic brain injury (TBI) in Europe, and to quantify variation across centers. Methods: This is a prospective observational multicenter study conducted across 18 countries in Europe and Israel. Admission characteristics, clinical data, and outcome were described at patient- and center levels. Between-center variation in the total ICU population was quantified with the median odds ratio (MOR), with correction for case-mix and random variation between centers. Results: A total of 2138 patients were admitted to the ICU, with median age of 49 years; 36% of which were mild TBI (Glasgow Coma Scale; GCS 13–15). Within, 72 h 636 (30%) were discharged and 128 (6%) died. Early deaths and long-stay patients (> 72 h) had more severe injuries based on the GCS and neuroimaging characteristics, compared with short-stay patients. Long-stay patients received more monitoring and were treated at higher intensity, and experienced worse 6-month outcome compared to short-stay patients. Between-center variations were prominent in the proportion of short-stay patients (MOR = 2.3, p < 0.001), use of intracranial pressure (ICP) monitoring (MOR = 2.5, p < 0.001) and aggressive treatments (MOR = 2.9, p < 0.001); and smaller in 6-month outcome (MOR = 1.2, p = 0.01). Conclusions: Half of contemporary TBI patients at the ICU have mild to moderate head injury. Substantial between-center variations exist in ICU stay and treatment policies, and less so in outcome. It remains unclear whether admission of short-stay patients represents appropriate prudence or inappropriate use of clinical resources. © 2020, The Author(s).

Research Center/Unit :

CHU de Liège-Centre du Cerveau² - ULiège

Disciplines :

Neurosciences & behavior

Author, co-author :

Huijben, Jilske A.; Department of Public Health, Center for Medical Decision Sciences, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands

Wiegers, Eveline J. A.; Department of Public Health, Center for Medical Decision Sciences, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands

Lingsma, Hester F.; Department of Public Health, Center for Medical Decision Sciences, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands

Citerio, Giuseppe; School of Medicine and Surgery, University of Milano - Bicocca, Milan, Italy, Neurointensive Care, San Gerardo Hospital, ASST-Monza, Monza, Italy

Maas, Andrew I. R.; Department of Neurosurgery, Antwerp University Hospital, University of Antwerp, Edegem, Belgium

Menon, David K.; Division of Anaesthesia, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom

Ercole, Ari; Division of Anaesthesia, Addenbrooke’s Hospital, University of Cambridge, Cambridge, United Kingdom

Nelson, David; Section for Perioperative Medicine and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden

van der Jagt, Mathieu; Department of Intensive Care Adults, Erasmus MC Stroke Center, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands

Steyerberg, Ewout W.; Department of Public Health, Center for Medical Decision Sciences, Erasmus MC-University Medical Center Rotterdam, Rotterdam, Netherlands, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands

More authors (157 more)

Language :

English

Title :

Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis

Publication date :

2020

Journal title :

Intensive Care Medicine

ISSN :

0342-4642

eISSN :

1432-1238

Publisher :

Springer

Volume :

Issue :

Pages :

995-1004

Peer reviewed :

Peer Reviewed verified by ORBi

European Projects :

FP7 - 602150 - CENTER-TBI - Collaborative European NeuroTrauma Effectiveness Research in TBI

Funders :

ZNS Hannelore Kohl Stiftung [DE]
One Mind [US-WA] [US-WA]
Integra LifeSciences [US-NJ] [US-NJ]
CE - Commission Européenne [BE]

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