Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis
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 an...
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| Veröffentlicht in: | Intensive care medicine 2020, Vol.46 (5), p.995-1004 |
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| creator | Huijben, Jilske A. Wiegers, Eveline J. A. Lingsma, Hester F. Citerio, Giuseppe Maas, Andrew I. R. Menon, David K. Ercole, Ari Nelson, David van der Jagt, Mathieu Steyerberg, Ewout W. Helbok, Raimund Lecky, Fiona Peul, Wilco Birg, Tatiana Zoerle, Tommaso Carbonara, Marco Stocchetti, Nino |
| description | 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
|
| doi_str_mv | 10.1007/s00134-020-05965-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_473194</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2400059024</sourcerecordid><originalsourceid>FETCH-LOGICAL-c702t-7442cf0eff1d1fb2bf9fead9880b7704ba7bb5c51afba27eff09dfc472026a203</originalsourceid><addsrcrecordid>eNp9k11v0zAUhiMEYmPwB7gAS9zARcBfiRMukEYpbFIFEhrcWieuk3qkTrGTTt2f4C9z2qwbm8SkSLHs57yvfT6S5Dmjbxml6l2klAmZUk5TmpV5ll4-SA6ZFDxlXBQPk0MqJE9lLvlB8iTGc8RVnrHHyYHgKEBzdpj8mSzAN843xECwZAX94gI2kYCfk8r2F9b61Fjf20BWAUzvjCVrCA561_lInMevtz66tR0V6i6QPsCwRMKQKsAOOR_ChoAJXYxkOoRuZd8TIJPp17Pp9_Ts4yn6QbuJLj5NHtXQRvvs6n-U_Pg8PZucpLNvX04nx7PUKMr7VEnJTU1tXbM5qyte1WVtYV4WBa2UorICVVWZyRjUFXCFHC3ntZGKU54Dp-IoSUfdeGFXQ6VXwS0hbHQHTl9t_cKV1VIJVkrky__yq9DNb4L2gVgIRiVl8l6vT-7nse5Co4floJliQm35DyOP8NLOt-kP0N62vHXi3UI33VorLCsXJQqIUaB1trEoXzm95rvA3XpoGw1GV1Zznheay7LkW9s3Y9TijtnJ8Uxv96gsBCtEuWbIvhxZE1zsnde-C6AZLTKui0zkGRKvrx4Rut-Djb1eumhs24K33RA1RwjrkMsc0Vd30PNuCNgQSEns06yku-vxvSV2UbD19R0Z1dt50OM8aJwHvZsHfYlBL_5N5XXIfgBuUhXxyDc23HjfI_sXqL8YbQ</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2400059024</pqid></control><display><type>article</type><title>Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis</title><source>MEDLINE</source><source>NORA - Norwegian Open Research Archives</source><source>SWEPUB Freely available online</source><source>SpringerLink Journals - AutoHoldings</source><creator>Huijben, Jilske A. ; Wiegers, Eveline J. A. ; Lingsma, Hester F. ; Citerio, Giuseppe ; Maas, Andrew I. R. ; Menon, David K. ; Ercole, Ari ; Nelson, David ; van der Jagt, Mathieu ; Steyerberg, Ewout W. ; Helbok, Raimund ; Lecky, Fiona ; Peul, Wilco ; Birg, Tatiana ; Zoerle, Tommaso ; Carbonara, Marco ; Stocchetti, Nino</creator><creatorcontrib>Huijben, Jilske A. ; Wiegers, Eveline J. A. ; Lingsma, Hester F. ; Citerio, Giuseppe ; Maas, Andrew I. R. ; Menon, David K. ; Ercole, Ari ; Nelson, David ; van der Jagt, Mathieu ; Steyerberg, Ewout W. ; Helbok, Raimund ; Lecky, Fiona ; Peul, Wilco ; Birg, Tatiana ; Zoerle, Tommaso ; Carbonara, Marco ; Stocchetti, Nino ; CENTER-TBI investigators and participants ; CENTER-TBI investigators and participants</creatorcontrib><description>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.</description><identifier>ISSN: 0342-4642</identifier><identifier>ISSN: 1432-1238</identifier><identifier>EISSN: 1432-1238</identifier><identifier>DOI: 10.1007/s00134-020-05965-z</identifier><identifier>PMID: 32100061</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Anesthesiology ; Brain ; Brain Injuries, Traumatic - therapy ; Coma ; Critical Care ; Critical Care Medicine ; Emergency Medicine ; Europe ; Glasgow Coma Scale ; Head injuries ; Human health and pathology ; Humans ; Injury analysis ; Intensive ; Intensive care ; Intensive care unit ; Intensive Care Units ; Intracranial pressure ; Israel - epidemiology ; Life Sciences ; Medical imaging ; Medicin och hälsovetenskap ; Medicine ; Medicine & Public Health ; Middle Aged ; Monitoring ; Neuroimaging ; Neurosciences & behavior ; Neurosciences & comportement ; Original ; Outcome ; Pain Medicine ; Patients ; Pediatrics ; Pneumology/Respiratory System ; Sciences sociales & comportementales, psychologie ; Social & behavioral sciences, psychology ; Telemedicine ; Traumatic brain injury ; Variation</subject><ispartof>Intensive care medicine, 2020, Vol.46 (5), p.995-1004</ispartof><rights>The Author(s) 2020</rights><rights>The Author(s) 2020. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>info:eu-repo/semantics/openAccess</rights><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c702t-7442cf0eff1d1fb2bf9fead9880b7704ba7bb5c51afba27eff09dfc472026a203</citedby><cites>FETCH-LOGICAL-c702t-7442cf0eff1d1fb2bf9fead9880b7704ba7bb5c51afba27eff09dfc472026a203</cites><orcidid>0000-0002-2892-5406</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00134-020-05965-z$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00134-020-05965-z$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,552,780,784,885,4024,26567,27923,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32100061$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://hal.science/hal-04831839$$DView record in HAL$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-171374$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:143104014$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Huijben, Jilske A.</creatorcontrib><creatorcontrib>Wiegers, Eveline J. A.</creatorcontrib><creatorcontrib>Lingsma, Hester F.</creatorcontrib><creatorcontrib>Citerio, Giuseppe</creatorcontrib><creatorcontrib>Maas, Andrew I. R.</creatorcontrib><creatorcontrib>Menon, David K.</creatorcontrib><creatorcontrib>Ercole, Ari</creatorcontrib><creatorcontrib>Nelson, David</creatorcontrib><creatorcontrib>van der Jagt, Mathieu</creatorcontrib><creatorcontrib>Steyerberg, Ewout W.</creatorcontrib><creatorcontrib>Helbok, Raimund</creatorcontrib><creatorcontrib>Lecky, Fiona</creatorcontrib><creatorcontrib>Peul, Wilco</creatorcontrib><creatorcontrib>Birg, Tatiana</creatorcontrib><creatorcontrib>Zoerle, Tommaso</creatorcontrib><creatorcontrib>Carbonara, Marco</creatorcontrib><creatorcontrib>Stocchetti, Nino</creatorcontrib><creatorcontrib>CENTER-TBI investigators and participants</creatorcontrib><creatorcontrib>CENTER-TBI investigators and participants</creatorcontrib><title>Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis</title><title>Intensive care medicine</title><addtitle>Intensive Care Med</addtitle><addtitle>Intensive Care Med</addtitle><description>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.</description><subject>Anesthesiology</subject><subject>Brain</subject><subject>Brain Injuries, Traumatic - therapy</subject><subject>Coma</subject><subject>Critical Care</subject><subject>Critical Care Medicine</subject><subject>Emergency Medicine</subject><subject>Europe</subject><subject>Glasgow Coma Scale</subject><subject>Head injuries</subject><subject>Human health and pathology</subject><subject>Humans</subject><subject>Injury analysis</subject><subject>Intensive</subject><subject>Intensive care</subject><subject>Intensive care unit</subject><subject>Intensive Care Units</subject><subject>Intracranial pressure</subject><subject>Israel - epidemiology</subject><subject>Life Sciences</subject><subject>Medical imaging</subject><subject>Medicin och hälsovetenskap</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Monitoring</subject><subject>Neuroimaging</subject><subject>Neurosciences & behavior</subject><subject>Neurosciences & comportement</subject><subject>Original</subject><subject>Outcome</subject><subject>Pain Medicine</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Pneumology/Respiratory System</subject><subject>Sciences sociales & comportementales, psychologie</subject><subject>Social & behavioral sciences, psychology</subject><subject>Telemedicine</subject><subject>Traumatic brain injury</subject><subject>Variation</subject><issn>0342-4642</issn><issn>1432-1238</issn><issn>1432-1238</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>3HK</sourceid><sourceid>D8T</sourceid><recordid>eNp9k11v0zAUhiMEYmPwB7gAS9zARcBfiRMukEYpbFIFEhrcWieuk3qkTrGTTt2f4C9z2qwbm8SkSLHs57yvfT6S5Dmjbxml6l2klAmZUk5TmpV5ll4-SA6ZFDxlXBQPk0MqJE9lLvlB8iTGc8RVnrHHyYHgKEBzdpj8mSzAN843xECwZAX94gI2kYCfk8r2F9b61Fjf20BWAUzvjCVrCA561_lInMevtz66tR0V6i6QPsCwRMKQKsAOOR_ChoAJXYxkOoRuZd8TIJPp17Pp9_Ts4yn6QbuJLj5NHtXQRvvs6n-U_Pg8PZucpLNvX04nx7PUKMr7VEnJTU1tXbM5qyte1WVtYV4WBa2UorICVVWZyRjUFXCFHC3ntZGKU54Dp-IoSUfdeGFXQ6VXwS0hbHQHTl9t_cKV1VIJVkrky__yq9DNb4L2gVgIRiVl8l6vT-7nse5Co4floJliQm35DyOP8NLOt-kP0N62vHXi3UI33VorLCsXJQqIUaB1trEoXzm95rvA3XpoGw1GV1Zznheay7LkW9s3Y9TijtnJ8Uxv96gsBCtEuWbIvhxZE1zsnde-C6AZLTKui0zkGRKvrx4Rut-Djb1eumhs24K33RA1RwjrkMsc0Vd30PNuCNgQSEns06yku-vxvSV2UbD19R0Z1dt50OM8aJwHvZsHfYlBL_5N5XXIfgBuUhXxyDc23HjfI_sXqL8YbQ</recordid><startdate>2020</startdate><enddate>2020</enddate><creator>Huijben, Jilske A.</creator><creator>Wiegers, Eveline J. A.</creator><creator>Lingsma, Hester F.</creator><creator>Citerio, Giuseppe</creator><creator>Maas, Andrew I. R.</creator><creator>Menon, David K.</creator><creator>Ercole, Ari</creator><creator>Nelson, David</creator><creator>van der Jagt, Mathieu</creator><creator>Steyerberg, Ewout W.</creator><creator>Helbok, Raimund</creator><creator>Lecky, Fiona</creator><creator>Peul, Wilco</creator><creator>Birg, Tatiana</creator><creator>Zoerle, Tommaso</creator><creator>Carbonara, Marco</creator><creator>Stocchetti, Nino</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><general>Springer Verlag</general><general>Springer</general><scope>C6C</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>3HK</scope><scope>1XC</scope><scope>Q33</scope><scope>5PM</scope><scope>ADHXS</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>D93</scope><scope>ZZAVC</scope><orcidid>https://orcid.org/0000-0002-2892-5406</orcidid></search><sort><creationdate>2020</creationdate><title>Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis</title><author>Huijben, Jilske A. ; Wiegers, Eveline J. A. ; Lingsma, Hester F. ; Citerio, Giuseppe ; Maas, Andrew I. R. ; Menon, David K. ; Ercole, Ari ; Nelson, David ; van der Jagt, Mathieu ; Steyerberg, Ewout W. ; Helbok, Raimund ; Lecky, Fiona ; Peul, Wilco ; Birg, Tatiana ; Zoerle, Tommaso ; Carbonara, Marco ; Stocchetti, Nino</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c702t-7442cf0eff1d1fb2bf9fead9880b7704ba7bb5c51afba27eff09dfc472026a203</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Anesthesiology</topic><topic>Brain</topic><topic>Brain Injuries, Traumatic - therapy</topic><topic>Coma</topic><topic>Critical Care</topic><topic>Critical Care Medicine</topic><topic>Emergency Medicine</topic><topic>Europe</topic><topic>Glasgow Coma Scale</topic><topic>Head injuries</topic><topic>Human health and pathology</topic><topic>Humans</topic><topic>Injury analysis</topic><topic>Intensive</topic><topic>Intensive care</topic><topic>Intensive care unit</topic><topic>Intensive Care Units</topic><topic>Intracranial pressure</topic><topic>Israel - epidemiology</topic><topic>Life Sciences</topic><topic>Medical imaging</topic><topic>Medicin och hälsovetenskap</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Monitoring</topic><topic>Neuroimaging</topic><topic>Neurosciences & behavior</topic><topic>Neurosciences & comportement</topic><topic>Original</topic><topic>Outcome</topic><topic>Pain Medicine</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Pneumology/Respiratory System</topic><topic>Sciences sociales & comportementales, psychologie</topic><topic>Social & behavioral sciences, psychology</topic><topic>Telemedicine</topic><topic>Traumatic brain injury</topic><topic>Variation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Huijben, Jilske A.</creatorcontrib><creatorcontrib>Wiegers, Eveline J. A.</creatorcontrib><creatorcontrib>Lingsma, Hester F.</creatorcontrib><creatorcontrib>Citerio, Giuseppe</creatorcontrib><creatorcontrib>Maas, Andrew I. R.</creatorcontrib><creatorcontrib>Menon, David K.</creatorcontrib><creatorcontrib>Ercole, Ari</creatorcontrib><creatorcontrib>Nelson, David</creatorcontrib><creatorcontrib>van der Jagt, Mathieu</creatorcontrib><creatorcontrib>Steyerberg, Ewout W.</creatorcontrib><creatorcontrib>Helbok, Raimund</creatorcontrib><creatorcontrib>Lecky, Fiona</creatorcontrib><creatorcontrib>Peul, Wilco</creatorcontrib><creatorcontrib>Birg, Tatiana</creatorcontrib><creatorcontrib>Zoerle, Tommaso</creatorcontrib><creatorcontrib>Carbonara, Marco</creatorcontrib><creatorcontrib>Stocchetti, Nino</creatorcontrib><creatorcontrib>CENTER-TBI investigators and participants</creatorcontrib><creatorcontrib>CENTER-TBI investigators and participants</creatorcontrib><collection>Springer Nature OA Free Journals</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>NORA - Norwegian Open Research Archives</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>Université de Liège - Open Repository and Bibliography (ORBI)</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SWEPUB Umeå universitet full text</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SWEPUB Umeå universitet</collection><collection>SwePub Articles full text</collection><jtitle>Intensive care medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Huijben, Jilske A.</au><au>Wiegers, Eveline J. A.</au><au>Lingsma, Hester F.</au><au>Citerio, Giuseppe</au><au>Maas, Andrew I. R.</au><au>Menon, David K.</au><au>Ercole, Ari</au><au>Nelson, David</au><au>van der Jagt, Mathieu</au><au>Steyerberg, Ewout W.</au><au>Helbok, Raimund</au><au>Lecky, Fiona</au><au>Peul, Wilco</au><au>Birg, Tatiana</au><au>Zoerle, Tommaso</au><au>Carbonara, Marco</au><au>Stocchetti, Nino</au><aucorp>CENTER-TBI investigators and participants</aucorp><aucorp>CENTER-TBI investigators and participants</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis</atitle><jtitle>Intensive care medicine</jtitle><stitle>Intensive Care Med</stitle><addtitle>Intensive Care Med</addtitle><date>2020</date><risdate>2020</risdate><volume>46</volume><issue>5</issue><spage>995</spage><epage>1004</epage><pages>995-1004</pages><issn>0342-4642</issn><issn>1432-1238</issn><eissn>1432-1238</eissn><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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>32100061</pmid><doi>10.1007/s00134-020-05965-z</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-2892-5406</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | Intensive care medicine, 2020, Vol.46 (5), p.995-1004 |
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| language | eng |
| recordid | cdi_swepub_primary_oai_swepub_ki_se_473194 |
| source | MEDLINE; NORA - Norwegian Open Research Archives; SWEPUB Freely available online; SpringerLink Journals - AutoHoldings |
| subjects | Anesthesiology Brain Brain Injuries, Traumatic - therapy Coma Critical Care Critical Care Medicine Emergency Medicine Europe Glasgow Coma Scale Head injuries Human health and pathology Humans Injury analysis Intensive Intensive care Intensive care unit Intensive Care Units Intracranial pressure Israel - epidemiology Life Sciences Medical imaging Medicin och hälsovetenskap Medicine Medicine & Public Health Middle Aged Monitoring Neuroimaging Neurosciences & behavior Neurosciences & comportement Original Outcome Pain Medicine Patients Pediatrics Pneumology/Respiratory System Sciences sociales & comportementales, psychologie Social & behavioral sciences, psychology Telemedicine Traumatic brain injury Variation |
| title | Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-24T20%3A00%3A47IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_swepu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Changing%20care%20pathways%20and%20between-center%20practice%20variations%20in%20intensive%20care%20for%20traumatic%20brain%20injury%20across%20Europe:%20a%20CENTER-TBI%20analysis&rft.jtitle=Intensive%20care%20medicine&rft.au=Huijben,%20Jilske%20A.&rft.aucorp=CENTER-TBI%20investigators%20and%20participants&rft.date=2020&rft.volume=46&rft.issue=5&rft.spage=995&rft.epage=1004&rft.pages=995-1004&rft.issn=0342-4642&rft.eissn=1432-1238&rft_id=info:doi/10.1007/s00134-020-05965-z&rft_dat=%3Cproquest_swepu%3E2400059024%3C/proquest_swepu%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2400059024&rft_id=info:pmid/32100061&rfr_iscdi=true |