Primary versus early secondary referral to a specialized neurotrauma center in patients with moderate/severe traumatic brain injury: a CENTER TBI study
Creators: name: Sewalt, Charlie Aletta
name: Gravesteijn, Benjamin Yaël
name: Menon, David
name: Lingsma, Hester Floor
name: Maas, Andrew I. R.
name: Stocchetti, Nino
name: Venema, Esmee
name: Lecky, Fiona E.
name: Åkerlund, Cecilia
name: Amrein, Krisztina
name: Andelic, Nada
name: Andreassen, Lasse
name: Anke, Audny
name: Antoni, Anna
name: Audibert, Gérard
name: Azouvi, Philippe
name: Azzolini, Maria Luisa
name: Bartels, Ronald
name: Barzó, Pál
name: Beauvais, Romuald
name: Beer, Ronny
name: Bellander, Bo-Michael
name: Belli, Antonio
name: Benali, Habib
name: Berardino, Maurizio
name: Beretta, Luigi
name: Blaabjerg, Morten
name: Bragge, Peter
name: Brazinova, Alexandra
name: Brinck, Vibeke
name: Brooker, Joanne
name: Brorsson, Camilla
name: Buki, Andras
name: Bullinger, Monika
name: Cabeleira, Manuel
name: Caccioppola, Alessio
name: Calappi, Emiliana
name: Calvi, Maria Rosa
name: Cameron, Peter
name: Lozano, Guillermo Carbayo
name: Carbonara, Marco
name: Chevallard, Giorgio
name: Chieregato, Arturo
name: Citerio, Giuseppe
name: Cnossen, Maryse
name: Coburn, Mark
name: Coles, Jonathan
name: Cooper, D. Jamie
name: Correia, Marta
name: Čović, Amra
name: Curry, Nicola
name: Czeiter, Endre
name: Czosnyka, Marek
name: Dahyot-Fizelier, Claire
name: Dawes, Helen
name: De Keyser, Véronique
name: Degos, Vincent
name: Corte, Francesco Della
name: Boogert, Hugo Den
name: Depreitere, Bart
name: Đilvesi, Đula
name: Dixit, Abhishek
name: Donoghue, Emma
name: Dreier, Jens
name: Dulière, Guy-Loup
name: Ercole, Ari
name: Esser, Patrick
name: Ezer, Erzsébet
name: Fabricius, Martin
name: Feigin, Valery L.
name: Foks, Kelly
name: Frisvold, Shirin
name: Furmanov, Alex
name: Gagliardo, Pablo
name: Galanaud, Damien
name: Gantner, Dashiell
name: Gao, Guoyi
name: George, Pradeep
name: Ghuysen, Alexandre
name: Giga, Lelde
name: Glocker, Ben
name: Golubovic, Jagoš
name: Gomez, Pedro A.
name: Gratz, Johannes
name: Gravesteijn, Benjamin
name: Grossi, Francesca
name: Gruen, Russell L.
name: Gupta, Deepak
name: Haagsma, Juanita A.
name: Haitsma, Iain
name: Helbok, Raimund
name: Helseth, Eirik
name: Horton, Lindsay
name: Huijben, Jilske
name: Hutchinson, Peter J.
name: Jacobs, Bram
name: Jankowski, Stefan
name: Jarrett, Mike
name: Jiang, Ji-Yao
name: Jones, Kelly
name: Karan, Mladen
name: Kolias, Angelos G.
name: Kompanje, Erwin
name: Kondziella, Daniel
name: Koraropoulos, Evgenios
name: Koskinen, Lars-Owe
name: Kovács, Noémi
name: Lagares, Alfonso
name: Lanyon, Linda
name: Laureys, Steven
name: Lecky, Fiona
name: Lefering, Rolf
name: Legrand, Valerie
name: Lejeune, Aurelie
name: Levi, Leon
name: Lightfoot, Roger
name: Lingsma, Hester
name: Castaño-León, Ana M.
name: Maegele, Marc
name: Majdan, Marek
name: Manara, Alex
name: Manley, Geoffrey
name: Martino, Costanza
name: Maréchal, Hugues
name: Mattern, Julia
name: McMahon, Catherine
name: Melegh, Béla
name: Menovsky, Tomas
name: Mulazzi, Davide
name: Muraleedharan, Visakh
name: Murray, Lynnette
name: Nair, Nandesh
name: Negru, Ancuta
name: Nelson, David
name: Newcombe, Virginia
name: Nieboer, Daan
name: Noirhomme, Quentin
name: Nyirádi, József
name: Olubukola, Otesile
name: Oresic, Matej
name: Ortolano, Fabrizio
name: Palotie, Aarno
name: Parizel, Paul M.
name: Payen, Jean-François
name: Perera, Natascha
name: Perlbarg, Vincent
name: Persona, Paolo
name: Peul, Wilco
name: Piippo-Karjalainen, Anna
name: Pirinen, Matti
name: Ples, Horia
name: Polinder, Suzanne
name: Pomposo, Inigo
name: Posti, Jussi P.
name: Puybasset, Louis
name: Radoi, Andreea
name: Ragauskas, Arminas
name: Raj, Rahul
name: Rambadagalla, Malinka
name: Real, Ruben
name: Rhodes, Jonathan
name: Richardson, Sylvia
name: Richter, Sophie
name: Ripatti, Samuli
name: Rocka, Saulius
name: Roe, Cecilie
name: Roise, Olav
name: Rosand, Jonathan
name: Rosenfeld, Jeffrey V.
name: Rosenlund, Christina
name: Rosenthal, Guy
name: Rossaint, Rolf
name: Rossi, Sandra
name: Rueckert, Daniel
name: Rusnák, Martin
name: Sahuquillo, Juan
name: Sakowitz, Oliver
name: Sanchez-Porras, Renan
name: Sandor, Janos
name: Schäfer, Nadine
name: Schmidt, Silke
name: Schoechl, Herbert
name: Schoonman, Guus
name: Schou, Rico Frederik
name: Schwendenwein, Elisabeth
name: Sewalt, Charlie
name: Skandsen, Toril
name: Smielewski, Peter
name: Sorinola, Abayomi
name: Stamatakis, Emmanuel
name: Stanworth, Simon
name: Kowark, Ana
name: Stevens, Robert
name: Stewart, William
name: Steyerberg, Ewout W.
name: Sundström, Nina
name: Synnot, Anneliese
name: Takala, Riikka
name: Tamás, Viktória
name: Tamosuitis, Tomas
name: Taylor, Mark Steven
name: Ao, Braden Te
name: Tenovuo, Olli
name: Theadom, Alice
name: Thomas, Matt
name: Tibboel, Dick
name: Timmers, Marjolein
name: Tolias, Christos
name: Trapani, Tony
name: Tudora, Cristina Maria
name: Vajkoczy, Peter
name: Vallance, Shirley
name: Valeinis, Egils
name: Vámos, Zoltán
name: Van Der Steen, Gregory
name: Van Der Naalt, Joukje
name: Van Dijck, Jeroen T. J. M.
name: Van Essen, Thomas A.
name: Van Hecke, Wim
name: Van Heugten, Caroline
name: Van Praag, Dominique
name: Vyvere, Thijs Vande
name: Vanhaudenhuyse, Audrey
name: Van Wijk, Roel P. J.
name: Vargiolu, Alessia
name: Vega, Emmanuel
name: Velt, Kimberley
name: Verheyden, Jan
name: Vespa, Paul M.
name: Vik, Anne
name: Vilcinis, Rimantas
name: Volovici, Victor
name: Von Steinbüchel, Nicole
name: Voormolen, Daphne
name: Vulekovic, Petar
name: Wang, Kevin K. W.
name: Wiegers, Eveline
name: Williams, Guy
name: Wilson, Lindsay
name: Winzeck, Stefan
name: Wolf, Stefan
name: Yang, Zhihui
name: Ylén, Peter
name: Younsi, Alexander
name: Zeiler, Frederik A.
name: Zelinkova, Veronika
name: Ziverte, Agate
name: Zoerle, Tommaso
Publisher: name: Apollo - University of Cambridge Repository
Year: 2021
Subjects: Original Research
Traumatic brain injury
Referral
Transfer
Trauma system

description: Funder: ZNS - Hannelore Kohl Stiftung; doi: http://dx.doi.org/10.13039/501100007731
description: Funder: Integra LifeSciences Corporation
description: Funder: OneMind
description: Abstract: 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 &lt; 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.