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

Maryse Cnossen, Suzanne Polinder, Hester F. Lingsma, Andrew Maas, David K. Menon, Ewout W. Steyerberg, Hadie Adams, Masala Alessandro, Judith E. 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 Bražinová, Felix Brehar, Camilla Brorsson, Andras Buki, Monika Bullinger, Veronika Bučková, E. Calappi, Peter Cameron, Lozano Guillermo Carbayo, Elsa Carise, C. Carpenter, Ana M. Castaño-León, F. Causin, G. Chevallard, Arturo Chieregato, Guiseppe Citerio, Mark Coburn, Jonathan P. Coles, Jamie D. Cooper, Marta Correia, Amra Covic, Nicola Curry, Endre Czeiter, Marek Czosnyka, Claire Dahyot-Fizelier, François Damas, Pierre Damas, Helen Dawes, Véronique De Keyser, Francesco Della Corte, Bart Depreitere, Shenghao Ding, Diederik W J Dippel, Kemal Dizdarevic, Guy Loup Dulière, Adelaida Dzeko, George Eapen, Heiko Engemann, Ari Ercole, Patrick Esser, Erzsébet Ezer, Martin Fabricius, Valery L. Feigin, Junfeng Feng, Kelly Foks, Francesca Fossi, Gilles Francony, Janek Frantzén, Ulderico Freo, Shirin Kordasti Frisvold, Alex Furmanov, Pablo Gagliardo, Damien Galanaud, Guoyi Gao, Karin Geleijns, Alexandre Ghuysen, Benoit Giraud, Ben Glocker, Pedro A. Gomez, Francesca Grossi, Russel Gruen, Deepak Gupta, Juanita A. Haagsma, Ermin Hadzic, Ian Haitsma, Jed A. Hartings, Raimund Helbok, Eirik Helseth, Daniel Hertle, Sean Hill, Astrid Hoedemaekers, Stefan Hoefer, Peter J. Hutchinson, Asta Kristine Håberg, Bram Jacobs, Ivan Janciak, Koen Janssens, Ji Yao Jiang, Kelly Jones, Jean Pierre Kalala, Konstantinos Kamnitsas, Mladen Karan, Jana Karau, Ari Katila, Maija Kaukonen, D. Keeling, Thomas Kerforne, Naomi Ketharanathan, Johannes Kettunen, Riku Kivisaari, Angelos G. Kolias, Bálint Kolumbán, E. J O Kompanje, Daniel Kondziella, Lars Owe Koskinen, Noémi Kovács, Ferenc Kalovits, Alfonso Lagares, Linda Lanyon, Steven Laureys, Martin Lauritzen, Fiona Lecky, Christian Ledig, Rolf Lefering, Valerie Legrand, Jin Lei, Leon Levi, Roger Lightfoot, Hester F. Lingsma, Dirk Loeckx, Angels Lozano, Roger Luddington, Chantal Luijten-Arts, Andrew I. Maas, Stephen MacDonald, Charles MacFayden, Marc Maegele, Marek Majdan, Sebastian Major, Alex Manara, Pauline Manhes, Geoffrey T. Manley, Didier Martin, Costanza Martino, Armando Maruenda, Hugues Maréchal, Dagmara Mastelova, Julia Mattern, Catherine McMahon, Béla Melegh, Tomas Menovsky, Cristina Morganti-Kossmann, Davide Mulazzi, Manuel Mutschler, Holger Mühlan, Ancuta Negru, David Nelson, Eddy Neugebauer, Virginia F. Newcombe, Quentin Noirhomme, József Nyirádi, Mauro Oddo, Annemarie Oldenbeuving, Matej Oresic, Fabrizio Ortolano, Aarno Palotie, Paul Parizel, Adriana Patruno, Jean François Payen, Natascha Perera, Vincent Perlbarg, Paolo Persona, Wilco Peul, Nicolas Pichon, Henning Piilgaard, Anna Piippo, Floury Sébastien Pili, Matti Pirinen, Horia Ples, Inigo Pomposo, Marek Psota, Pim Pullens, Louis Puybasset, Arminas Ragauskas, Rahul Raj, Malinka Rambadagalla, Veronika Rehorčíková, Jonathan K J Rhodes, Sylvia Richardson, Samuli Ripatti, Saulius Rocka, Nicolas Rodier, Cecilie Roe, Olav Roise, Gerwin Roks, Pauline Romegoux, Jonathan Rosand, Jeffrey Rosenfeld, Christina Rosenlund, Guy Rosenthal, Rolf Rossaint, Sandra Rossi, Tim Rostalski, Danie L. Rueckert, Felix Ruiz De Arcaute, Martin Rusnák, Marco Sacchi, Barbara Sahakian, Juan Sahuquillo, Oliver Sakowitz, Francesca Sala, Paola Sanchez-Pena, Renan Sanchez-Porras, Janos Sandor, Edgar Santos, Nadine Sasse, Luminita Sasu, Davide Savo, Inger Schipper, Barbara Schlößer, Silke Schmidt, Annette Schneider, Herbert Schoechl, G. G. Schoonman, Rico Schou, Elisabeth Schwendenwein, Michael Schöll, Özcan Sir, Toril Skandsen, Lidwien Smakman, Dirk Smeets, Peter Smielewski, Abayomi Sorinola, Emmanue L. Stamatakis, Simon Stanworth, Katrin Stegemann, Nicole Steinbüchel, Robert Stevens, William Stewart, Nino Stocchetti, Nina Sundström, Anneliese J. Synnot, József Szabó, Jeannette Söderberg, F. S. Taccone, Viktória Tamás, Päivi Tanskanen, Alexandru Tascu, Mark Steven Taylor, Braden Te Ao, Olli Tenovuo, Guido Teodorani, Alice Theadom, Matt Thomas, Dick Tibboel, Christos M. Tolias, Jean Flory Luaba Tshibanda, Cristina Maria Tudora, Peter Vajkoczy, Egils Valeinis, Wim Van Hecke, Dominique Van Praag, Dirk Van Roost, Eline Van Vlierberghe, Thijs Vande Vyvere, Audrey Vanhaudenhuyse, Alessia Vargiolu, Emmanuel Vega, Jan Verheyden, Paul M. Vespa, Anne Vik, Rimantas Vilcinis, Giacinta Vizzino, Carmen Vleggeert-Lankamp, Victor Volovici, Peter Vulekovic, Zoltán Vámos, Derick Wade, Kevin K W Wang, Lei Wang, Eno Wildschut, Guy Williams, Lisette Willumsen, Adam Wilson, Lindsay Wilson, Maren K L Winkler, Peter Ylén, Alexander Younsi, Menashe Zaaroor, Zhiqun Zhang, Zelong Zheng, Fabrizio Zumbo, Stefanie De Lange, Godard C W De Ruiter, Hugo Den Boogert, Jeroen Van Dijck, Thomas Van Essen, C. M. Van Heugten, Mathieu Van Der Jagt, Joukje Van Der Naalt

Research output: Contribution to journalArticle

Abstract

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
Volume11
Issue number8
DOIs
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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    Cnossen, M., Polinder, S., Lingsma, H. F., Maas, A., Menon, D. K., Steyerberg, E. W., Adams, H., Alessandro, M., Allanson, J. E., Amrein, K., Andaluz, N., Andelic, N., Andrea, N., Andreassen, L., Anke, A., Antoni, A., Ardon, H., Audibert, G., Auslands, K., ... Van Der Naalt, J. (2016). Variation in structure and process of care in traumatic brain injury: Provider profiles of European Neurotrauma Centers participating in the CENTER-TBI study. PLoS One, 11(8), [e0161367]. https://doi.org/10.1371/journal.pone.0161367