Intensive care admission criteria for traumatic brain injury patients across Europe

Victor Volovici, Ari Ercole, Giuseppe Citerio, Nino Stocchetti, Iain K. Haitsma, Jilske A. Huijben, Clemens M.F. Dirven, Mathieu van der Jagt, Ewout W. Steyerberg, David Nelson, Maryse C. Cnossen, Andrew I.R. Maas, Suzanne Polinder, David K. Menon, Hester F. Lingsma

Research output: Contribution to journalArticle

Abstract

Within a prospective, observational, multi-center cohort study 68 hospitals (of which 66 responded), mostly academic (n = 60, 91%) level I trauma centers (n = 44, 67%) in 20 countries were asked to complete questionnaires regarding the “standard of care” for severe neurotrauma patients in their hospitals. From the questionnaire pertaining to ICU management, 12 questions related to admission criteria were selected for this analysis. The questionnaires were completed by 66 centers. The median number of TBI patients admitted to the ICU was 92 [interquartile range (IQR): 52–160] annually. Admission policy varied; in 45 (68%) centers, patients with a Glasgow Come Score (GCS) between 13 and 15 without CT abnormalities but with other risk factors would be admitted to the ICU while the rest indicated that they would not admit these patients routinely to the ICU. We found no association between ICU admission policy and the presence of a dedicated neuro ICU, the discipline in charge of rounds, the presence of step down beds or geographic location (North- Western Europe vs. South – Eastern Europe and Israel). Variation in admission policy, primarily of mild TBI patients to ICU exists, even among high-volume academic centers and seems to be largely independent of other center characteristics. The observed variation suggests a role for comparative effectiveness research to investigate the potential benefit and cost-effectiveness of a liberal versus more restrictive admission policies.

Original languageEnglish
Pages (from-to)158-161
Number of pages4
JournalJournal of Critical Care
Volume49
DOIs
Publication statusPublished - Feb 1 2019

Keywords

  • CENTER-TBI
  • Cost-effectiveness
  • European policy
  • Intensive care admission
  • Intensive care occupancy
  • Moderate and Severe TBI

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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  • Cite this

    Volovici, V., Ercole, A., Citerio, G., Stocchetti, N., Haitsma, I. K., Huijben, J. A., Dirven, C. M. F., van der Jagt, M., Steyerberg, E. W., Nelson, D., Cnossen, M. C., Maas, A. I. R., Polinder, S., Menon, D. K., & Lingsma, H. F. (2019). Intensive care admission criteria for traumatic brain injury patients across Europe. Journal of Critical Care, 49, 158-161. https://doi.org/10.1016/j.jcrc.2018.11.002