Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis

CENTER-TBI Investigators and Participants, Jilske A. Huijben, Eveline J.A. Wiegers, Hester F. Lingsma, Giuseppe Citerio, Andrew I.R. Maas, David K. Menon, Ari Ercole, David Nelson, Mathieu van der Jagt, Ewout W. Steyerberg, Raimund Helbok, Fiona Lecky, Wilco Peul, Tatiana Birg, Tommaso Zoerle, Marco Carbonara, Nino Stocchetti

Research output: Contribution to journalArticlepeer-review

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 (> 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.

Original languageEnglish
Pages (from-to)995-1004
Number of pages10
JournalIntensive Care Medicine
Volume46
Issue number5
DOIs
Publication statusPublished - May 1 2020

Keywords

  • Intensive care unit
  • Intracranial pressure
  • Outcome
  • Traumatic brain injury

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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