Article (Scientific journals)
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, David et al.
2021In Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 29 (1), p. 113
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Keywords :
Brain Injuries, Traumatic/diagnosis/therapy; Glasgow Coma Scale; Glasgow Outcome Scale; Humans; Prospective Studies; Referral and Consultation; Referral; Transfer; Trauma system; Traumatic brain injury
Abstract :
[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
Brazinova, Alexandra
Tibboel, Dick
Timmers, Marjolein
Tolias, Christos
Trapani, Tony
Tudora, Cristina Maria
Vajkoczy, Peter
Vallance, Shirley
Valeinis, Egils
Vámos, Zoltán
Lecky, Fiona
Van der Steen, Gregory
Brinck, Vibeke
van der Naalt, Joukje
van Dijck, Jeroen T J M
van Essen, Thomas A
Van Hecke, Wim
van Heugten, Caroline
Van Praag, Dominique
Vyvere, Thijs Vande
Vanhaudenhuyse, Audrey  ;  Université de Liège - ULiège > Département des sciences cliniques
Lefering, Rolf
van Wijk, Roel P J
Vargiolu, Alessia
Brooker, Joanne
Vega, Emmanuel
Velt, Kimberley
Verheyden, Jan
Vespa, Paul M
Vik, Anne
Vilcinis, Rimantas
Volovici, Victor
Legrand, Valerie
von Steinbüchel, Nicole
Voormolen, Daphne
Vulekovic, Petar
Brorsson, Camilla
Wang, Kevin K W
Wiegers, Eveline
Williams, Guy
Wilson, Lindsay
Winzeck, Stefan
Wolf, Stefan
Lejeune, Aurelie
Yang, Zhihui
Ylén, Peter
Younsi, Alexander
Zeiler, Frederik A
Buki, Andras
Zelinkova, Veronika
Ziverte, Agate
Zoerle, Tommaso
Bullinger, Monika
Cabeleira, Manuel
Levi, Leon
Caccioppola, Alessio
Calappi, Emiliana
Calvi, Maria Rosa
Cameron, Peter
Lozano, Guillermo Carbayo
Carbonara, Marco
Chevallard, Giorgio
Chieregato, Arturo
Citerio, Giuseppe
Cnossen, Maryse
Lightfoot, Roger
Coburn, Mark
Coles, Jonathan
Cooper, D Jamie
Correia, Marta
Čović, Amra
Curry, Nicola
Czeiter, Endre
Czosnyka, Marek
Dahyot-Fizelier, Claire
Dawes, Helen
Lingsma, Hester
De Keyser, Véronique ;  Université de Liège - ULiège > Département de Psychologie
Degos, Vincent
Corte, Francesco Della
Boogert, Hugo den
Depreitere, Bart
Đilvesi, Đula
Dixit, Abhishek
Donoghue, Emma
Dreier, Jens
Dulière, Guy-Loup
Maas, Andrew I R
Ercole, Ari
Esser, Patrick
Ezer, Erzsébet
Fabricius, Martin
Feigin, Valery L
Foks, Kelly
Frisvold, Shirin
Furmanov, Alex
Gagliardo, Pablo
Galanaud, Damien
Beauvais, Romuald
Gantner, Dashiell
Gao, Guoyi
George, Pradeep
GHUYSEN, Alexandre ;  Centre Hospitalier Universitaire de Liège - CHU > > Service des urgences
Giga, Lelde
Glocker, Ben
Golubovic, Jagoš
Gomez, Pedro A
Gratz, Johannes
Gravesteijn, Benjamin
Castaño-León, Ana M
Grossi, Francesca
Gruen, Russell L
Gupta, Deepak
Haagsma, Juanita A
Haitsma, Iain
Helbok, Raimund
Helseth, Eirik
Horton, Lindsay
Huijben, Jilske
Hutchinson, Peter J
Maegele, Marc
Jacobs, Bram
Jankowski, Stefan
Jarrett, Mike
Jiang, Ji-Yao
Jones, Kelly
Karan, Mladen
Kolias, Angelos G
Kompanje, Erwin
Kondziella, Daniel
Koraropoulos, Evgenios
Majdan, Marek
Koskinen, Lars-Owe
Kovács, Noémi
Lagares, Alfonso
Manara, Alex
Manley, Geoffrey
Martino, Costanza
Maréchal, Hugues
Mattern, Julia
McMahon, Catherine
Melegh, Béla
Beer, Ronny
Menon, David
Menovsky, Tomas
Mulazzi, Davide
Muraleedharan, Visakh
Murray, Lynnette
Nair, Nandesh
Negru, Ancuta
Nelson, David
Newcombe, Virginia
Nieboer, Daan
Bellander, Bo-Michael
Noirhomme, Quentin ;  Université de Liège - ULiège > GIGA > GIGA CRC In vivo Imaging
Nyirádi, József
Olubukola, Otesile
Oresic, Matej
Ortolano, Fabrizio
Palotie, Aarno
Parizel, Paul M
Payen, Jean-François
Perera, Natascha
Perlbarg, Vincent
Belli, Antonio
Persona, Paolo
Peul, Wilco
Piippo-Karjalainen, Anna
Pirinen, Matti
Ples, Horia
Polinder, Suzanne
Pomposo, Inigo
Posti, Jussi P
Puybasset, Louis
Radoi, Andreea
Benali, Habib
Ragauskas, Arminas
Raj, Rahul
Rambadagalla, Malinka
Real, Ruben
Rhodes, Jonathan
Richardson, Sylvia
Richter, Sophie
Ripatti, Samuli
Rocka, Saulius
Roe, Cecilie
Berardino, Maurizio
Roise, Olav
Rosand, Jonathan
Rosenfeld, Jeffrey V
Rosenlund, Christina
Rosenthal, Guy
Rossaint, Rolf
Rossi, Sandra
Rueckert, Daniel
Rusnák, Martin
Sahuquillo, Juan
Beretta, Luigi
Sakowitz, Oliver
Sanchez-Porras, Renan
Sandor, Janos
Schäfer, Nadine
Schmidt, Silke
Schoechl, Herbert
Schoonman, Guus
Schou, Rico Frederik
Schwendenwein, Elisabeth
Sewalt, Charlie
Blaabjerg, Morten
Skandsen, Toril
More authors (233 more) Less
Language :
English
Title :
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
eISSN :
1757-7241
Publisher :
BioMed Central, London, Gb
Volume :
29
Issue :
1
Pages :
113
Peer reviewed :
Peer Reviewed verified by ORBi
Funding number :
602150/FP7 Health/
Commentary :
© 2021. The Author(s).
Available on ORBi :
since 27 March 2022

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