| Title |
Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis / |
| Authors |
Huijben, Jilske A ; Wiegers, Eveline J.A ; Lingsma, Hester F ; Citerio, Giuseppe ; Maas, Andrew I.R ; Menon, David K ; Ercole, Ari ; Nelson, David ; Jagt, Mathieu van der ; Steyerberg, Ewout W ; Helbok, Raimund ; Lecky, Fiona ; Peul, Wilco ; Birg, Tatiana ; Zoerle, Tommaso ; Carbonara, Marco ; Stocchetti, Nino |
| DOI |
10.1007/s00134-020-05965-z |
| Full Text |
|
| Is Part of |
Intensive care medicine.. Weinheim : Springer. 2020, vol. 46, iss. 5, p. 995-1004.. ISSN 0342-4642. eISSN 1432-1238 |
| Keywords [eng] |
Intensive care unit ; Intracranial pressure ; Outcome ; Traumatic brain injury |
| Abstract [eng] |
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. |
| Published |
Weinheim : Springer |
| Type |
Journal article |
| Language |
English |
| Publication date |
2020 |
| CC license |
|
