Variation in structure and process of care in traumatic brain injury: Provider profiles of European Neurotrauma Centers participating in the CENTER-TBI study

Maryse C. Cnossen, Suzanne Polinder, Hester F. Lingsma, Andrew I R Maas, David Menon, Ewout W. Steyerberg, Hadie Adams, Masala Alessandro, Judith Allanson, Krisztina Amrein, Norberto Andaluz, Nada Andelic, Nanni Andrea, Lasse Andreassen, Audny Anke, Anna Antoni, Hilko Ardon, Gérard Audibert, Kaspars Auslands, Philippe AzouviCamelia Baciu, Andrew Bacon, Rafael Badenes, Trevor Baglin, Ronald Bartels, Pál Barzó, Ursula Bauerfeind, Ronny Beer, Francisco Javier Belda, Bo Michael Bellander, Antonio Belli, Rémy Bellier, Habib Benali, Thierry Benard, Maurizio Berardino, Luigi Beretta, Christopher Beynon, Federico Bilotta, Harald Binder, Erta Biqiri, Morten Blaabjerg, Lund Stine Borgen, Pierre Bouzat, Peter Bragge, Alexandra Brazinova, Felix Brehar, Camilla Brorsson, Andras Buki, Monika Bullinger, Nino Stocchetti, CENTER-TBI Investigators and Participants

Research output: Contribution to journalArticlepeer-review


Introduction: The strength of evidence underpinning care and treatment recommendations in traumatic brain injury (TBI) is low. Comparative effectiveness research (CER) has been proposed as a framework to provide evidence for optimal care for TBI patients. The first step in CER is to map the existing variation. The aim of current study is to quantify variation in general structural and process characteristics among centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Methods: We designed a set of 11 provider profiling questionnaires with 321 questions about various aspects of TBI care, chosen based on literature and expert opinion. After pilot testing, questionnaires were disseminated to 71 centers from 20 countries participating in the CENTER-TBI study. Reliability of questionnaires was estimated by calculating a concordance rate among 5% duplicate questions. Results: All 71 centers completed the questionnaires. Median concordance rate among duplicate questions was 0.85. The majority of centers were academic hospitals (n = 65, 92%), designated as a level I trauma center (n = 48, 68%) and situated in an urban location (n = 70, 99%). The availability of facilities for neuro-trauma care varied across centers; e.g. 40 (57%) had a dedicated neuro-intensive care unit (ICU), 36 (51%) had an in-hospital rehabilitation unit and the organization of the ICU was closed in 64% (n = 45) of the centers. In addition, we found wide variation in processes of care, such as the ICU admission policy and intracranial pressure monitoring policy among centers. Conclusion: Even among high-volume, specialized neurotrauma centers there is substantial variation in structures and processes of TBI care. This variation provides an opportunity to study effectiveness of specific aspects of TBI care and to identify best practices with CER approaches.

Original languageEnglish
Article numbere0161367
JournalPLoS One
Issue number8
Publication statusPublished - Aug 1 2016

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)


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