Primary versus early secondary referral to a specialized neurotrauma center in patients with moderate/severe traumatic brain injury: a CENTER TBI study.
Sewalt, Charlie Aletta; Gravesteijn, Benjamin Yaël; Menon, Davidet al.
2021 • In Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 29 (1), p. 113
[en] BACKGROUND: Prehospital care for patients with traumatic brain injury (TBI) varies with some emergency medical systems recommending direct transport of patients with moderate to severe TBI to hospitals with specialist neurotrauma care (SNCs). The aim of this study is to assess variation in levels of early secondary referral within European SNCs and to compare the outcomes of directly admitted and secondarily transferred patients. METHODS: Patients with moderate and severe TBI (Glasgow Coma Scale < 13) from the prospective European CENTER-TBI study were included in this study. All participating hospitals were specialist neuroscience centers. First, adjusted between-country differences were analysed using random effects logistic regression where early secondary referral was the dependent variable, and a random intercept for country was included. Second, the adjusted effect of early secondary referral on survival to hospital discharge and functional outcome [6 months Glasgow Outcome Scale Extended (GOSE)] was estimated using logistic and ordinal mixed effects models, respectively. RESULTS: A total of 1347 moderate/severe TBI patients from 53 SNCs in 18 European countries were included. Of these 1347 patients, 195 (14.5%) were admitted after early secondary referral. Secondarily referred moderate/severe TBI patients presented more often with a CT abnormality: mass lesion (52% vs. 34%), midline shift (54% vs. 36%) and acute subdural hematoma (77% vs. 65%). After adjusting for case-mix, there was a large European variation in early secondary referral, with a median OR of 1.69 between countries. Early secondary referral was not associated with functional outcome (adjusted OR 1.07, 95% CI 0.78-1.69), nor with survival at discharge (1.05, 0.58-1.90). CONCLUSIONS: Across Europe, substantial practice variation exists in the proportion of secondarily referred TBI patients at SNCs that is not explained by case mix. Within SNCs early secondary referral does not seem to impact functional outcome and survival after stabilisation in a non-specialised hospital. Future research should identify which patients with TBI truly benefit from direct transportation.
Disciplines :
Human health sciences: Multidisciplinary, general & others
Author, co-author :
Sewalt, Charlie Aletta ; Department of Public Health, Erasmus MC Medical Center, Postbus 2040, 3000 CA
Gravesteijn, Benjamin Yaël; Department of Public Health, Erasmus MC Medical Center, Postbus 2040, 3000 CA, ; Department of Anesthesiology, Erasmus MC Medical Center, Rotterdam, The Netherlands.
Menon, David; Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge,
Lingsma, Hester Floor; Department of Public Health, Erasmus MC Medical Center, Postbus 2040, 3000 CA,
Maas, Andrew I R; Department of Neurosurgery, Antwerp University Hospital, and University of Antwerp,
Stocchetti, Nino; Department of Pathophysiology and Transplantation, Milan University, and
Venema, Esmee; Department of Public Health, Erasmus MC Medical Center, Postbus 2040, 3000 CA, ; Department of Neurology, Erasmus MC Medical Center, Rotterdam, The Netherlands.
Lecky, Fiona E; Center for Urgent and Emergency Care Research (CURE), Health Services Research
CENTER TBI Participants and, Investigators
Other collaborator :
Åkerlund, Cecilia
Amrein, Krisztina
Andelic, Nada
Andreassen, Lasse
Anke, Audny
Antoni, Anna
Audibert, Gérard
Azouvi, Philippe
Azzolini, Maria Luisa
Bartels, Ronald
Barzó, Pál
Smielewski, Peter
Sorinola, Abayomi
Stamatakis, Emmanuel
Stanworth, Simon
Kowark, Ana
Stevens, Robert
Stewart, William
Steyerberg, Ewout W
Stocchetti, Nino
Bragge, Peter
Lanyon, Linda
Sundström, Nina
Synnot, Anneliese
Takala, Riikka
Tamás, Viktória
Tamosuitis, Tomas
Taylor, Mark Steven
Ao, Braden Te
Tenovuo, Olli
Theadom, Alice
Thomas, Matt
LAUREYS, Steven ; Centre Hospitalier Universitaire de Liège - CHU > > Centre du Cerveau²
Primary versus early secondary referral to a specialized neurotrauma center in patients with moderate/severe traumatic brain injury: a CENTER TBI study.
Publication date :
04 August 2021
Journal title :
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
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