TY - JOUR
T1 - Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe
T2 - a CENTER-TBI analysis
AU - CENTER-TBI Investigators and Participants
AU - Huijben, Jilske A.
AU - Wiegers, Eveline J.A.
AU - Lingsma, Hester F.
AU - Citerio, Giuseppe
AU - Maas, Andrew I.R.
AU - Menon, David K.
AU - Ercole, Ari
AU - Nelson, David
AU - van der Jagt, Mathieu
AU - Steyerberg, Ewout W.
AU - Helbok, Raimund
AU - Lecky, Fiona
AU - Peul, Wilco
AU - Birg, Tatiana
AU - Zoerle, Tommaso
AU - Carbonara, Marco
AU - Stocchetti, Nino
AU - Åkerlund, Cecilia
AU - Amrein, Krisztina
AU - Andelic, Nada
AU - Andreassen, Lasse
AU - Audibert, Gérard
AU - Azouvi, Philippe
AU - Azzolini, Maria Luisa
AU - Bartels, Ronald
AU - Beer, Ronny
AU - Bellander, Bo Michael
AU - Benali, Habib
AU - Berardino, Maurizio
AU - Beretta, Luigi
AU - Beqiri, Erta
AU - Blaabjerg, Morten
AU - Lund, Stine Borgen
AU - Brorsson, Camilla
AU - Buki, Andras
AU - Cabeleira, Manuel
AU - Caccioppola, Alessio
AU - Calappi, Emiliana
AU - Calvi, Maria Rosa
AU - Cameron, Peter
AU - Lozano, Guillermo Carbayo
AU - Castaño-León, Ana M.
AU - Cavallo, Simona
AU - Chevallard, Giorgio
AU - Chieregato, Arturo
AU - Coburn, Mark
AU - Coles, Jonathan
AU - Cooper, Jamie D.
AU - Correia, Marta
AU - Ortolano, Fabrizio
PY - 2020/5/1
Y1 - 2020/5/1
N2 - 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.
AB - 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.
KW - Intensive care unit
KW - Intracranial pressure
KW - Outcome
KW - Traumatic brain injury
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U2 - 10.1007/s00134-020-05965-z
DO - 10.1007/s00134-020-05965-z
M3 - Article
C2 - 32100061
AN - SCOPUS:85084271938
VL - 46
SP - 995
EP - 1004
JO - Intensive Care Medicine
JF - Intensive Care Medicine
SN - 0342-4642
IS - 5
ER -