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.
2020In Intensive Care Medicine, 46 (5), p. 995-1004
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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 :
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
Helbok, Raimund;  Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
Lecky, Fiona;  Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
Peul, Wilco;  University Neurosurgical Centre Holland, HMC, HAGA and LUMC, The Hague and Leiden, Netherlands
Birg, Tatiana;  Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Milan, Italy
Zoerle, Tommaso;  Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Milan, Italy
Carbonara, Marco;  Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Milan, Italy
Stocchetti, Nino;  Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Milan, Italy, Department of Pathophysiology and Transplants, University of Milan, Milan, Italy
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 ;  Université de Liège - ULiège > Département de Psychologie > Département de Psychologie
Degos, V.
Della Corte, F.
den Boogert, H.
Depreitere, B.
Dilvesi, D.
Dixit, A.
Dreier, J.
Ezer, E.
Fabricius, M.
Foks, K.
Frisvold, S.
Furmanov, A.
Galanaud, D.
Gantner, D.
Ghuysen, Alexandre ;  Université de Liège - ULiège > Département des sciences de la santé publique > Simulation médicale en situation critique
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  ;  Université de Liège - ULiège > Giga Consciousness-Coma Science Group
Lejeune, Aurélie
Lightfoot, R.
Manara, A.
Martino, C.
Maréchal, H.
Mattern, J.
McMahon, C.
Menovsky, T.
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
More authors (157 more) Less
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 :
46
Issue :
5
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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