Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis
Creators: name: Huijben, Jilske A.
name: Wiegers, Eveline J. A.
name: Lingsma, Hester F.
name: Citerio, Giuseppe
name: Maas, Andrew I. R.
name: Menon, David K.
name: Ercole, Ari
name: Nelson, David
name: Van Der Jagt, Mathieu
name: Steyerberg, Ewout W.
name: Helbok, Raimund
name: Lecky, Fiona
name: Peul, Wilco
name: Birg, Tatiana
name: Zoerle, Tommaso
name: Carbonara, Marco
name: Stocchetti, Nino
name: Åkerlund, Cecilia
name: Amrein, Krisztina
name: Andelic, Nada
name: Andreassen, Lasse
name: Audibert, Gérard
name: Azouvi, Philippe
name: Azzolini, Maria Luisa
name: Bartels, Ronald
name: Beer, Ronny
name: Bellander, Bo-Michael
name: Benali, Habib
name: Berardino, Maurizio
name: Beretta, Luigi
name: Beqiri, Erta
name: Blaabjerg, Morten
name: Lund, Stine Borgen
name: Brorsson, Camilla
name: Buki, Andras
name: Cabeleira, Manuel
name: Caccioppola, Alessio
name: Calappi, Emiliana
name: Calvi, Maria Rosa
name: Cameron, Peter
name: Lozano, Guillermo Carbayo
name: Castaño-León, Ana M.
name: Cavallo, Simona
name: Chevallard, Giorgio
name: Chieregato, Arturo
name: Coburn, Mark
name: Coles, Jonathan
name: Cooper, Jamie D.
name: Correia, Marta
name: Czeiter, Endre
name: Czosnyka, Marek
name: Dahyot-Fizelier, Claire
name: Dark, Paul
name: DeKeyser, Véronique
name: Degos, Vincent
name: Della Corte, Francesco
name: Den Boogert, Hugo
name: Depreitere, Bart
name: Dilvesi, Dula
name: Dixit, Abhishek
name: Dreier, Jens
name: Dulière, Guy-Loup
name: Ezer, Erzsébet
name: Fabricius, Martin
name: Foks, Kelly
name: Frisvold, Shirin
name: Furmanov, Alex
name: Galanaud, Damien
name: Gantner, Dashiell
name: Ghuysen, Alexandre
name: Giga, Lelde
name: Golubovic, Jagos
name: Gomez, Pedro A.
name: Grossi, Francesca
name: Gupta, Deepak
name: Haitsma, Iain
name: Helseth, Eirik
name: Hutchinson, Peter J.
name: Jankowski, Stefan
name: Johnson, Faye
name: Karan, Mladen
name: Kolias, AngelosG.
name: Kondziella, Daniel
name: Koraropoulos, Evgenios
name: Koskinen, Lars-Owe
name: Kovács, Noémi
name: Kowark, Ana
name: Lagares, Alfonso
name: Laureys, Steven
name: Ledoux, Didier
name: Lejeune, Aurelie
name: Lightfoot, Roger
name: Manara, Alex
name: Martino, Costanza
name: Maréchal, Hugues
name: Mattern, Julia
name: McMahon, Catherine
name: Menovsky, Tomas
name: Misset, Benoit
name: Muraleedharan, Visakh
name: Murray, Lynnette
name: Negru, Ancuta
name: Newcombe, Virginia
name: Nyirádi, József
name: Ortolano, Fabrizio
name: Payen, Jean-François
name: Perlbarg, Vincent
name: Persona, Paolo
name: Piippo-Karjalainen, Anna
name: Ples, Horia
name: Pomposo, Inigo
name: Posti, Jussi P.
name: Puybasset, Louis
name: Radoi, Andreea
name: Ragauskas, Arminas
name: Raj, Rahul
name: Rhodes, Jonathan
name: Richter, Sophie
name: Rocka, Saulius
name: Roe, Cecilie
name: Roise, Olav
name: Rosenfeld, Jeffrey V.
name: Rosenlund, Christina
name: Rosenthal, Guy
name: Rossaint, Rolf
name: Rossi, Sandra
name: Sahuquillo, Juan
name: Sandrød, Oddrun
name: Sakowitz, Oliver
name: Sanchez-Porras, Renan
name: Schirmer-Mikalsen, Kari
name: Schou, Rico Frederik
name: Smielewski, Peter
name: Sorinola, Abayomi
name: Stamatakis, Emmanuel
name: Sundström, Nina
name: Takala, Riikka
name: Tamás, Viktória
name: Tamosuitis, Tomas
name: Tenovuo, Olli
name: Thomas, Matt
name: Tibboel, Dick
name: Tolias, Christos
name: Trapani, Tony
name: Tudora, CristinaMaria
name: Vajkoczy, Peter
name: Vallance, Shirley
name: Valeinis, Egils
name: Vámos, Zoltán
name: Van Der Steen, Gregory
name: Van Wijk, Roel P. J.
name: Vargiolu, Alessia
name: Vega, Emmanuel
name: Vik, Anne
name: Vilcinis, Rimantas
name: Volovici, Victor
name: Vulekovic, Petar
name: Williams, Guy
name: Winzeck, Stefan
name: Wolf, Stefan
name: Younsi, Alexander
name: Zeiler, Frederick A.
name: Clusmann, Agate Ziverte Hans
name: Voormolen, Daphne
name: Van Dijck, Jeroen T. J. M.
name: Van Essen, Thomas A.
Publisher: name: Apollo - University of Cambridge Repository
Year: 2020
Subjects: Original
Intensive care unit
Traumatic brain injury
Intracranial pressure
Outcome

description: Abstract: 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 (&gt; 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 &lt; 0.001), use of intracranial pressure (ICP) monitoring (MOR = 2.5, p &lt; 0.001) and aggressive treatments (MOR = 2.9, p &lt; 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.