Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis
Intensive Care Medicine, vol. 46, pp. 995–1004
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.
Authors 17
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Jilske Antonia Huijben corresponding
Affiliation as printed
Department of Public Health, Center for Medical Decision Sciences, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands. j.a.huijben@erasmusmc.nl
Department of Public Health, Center for Medical Decision Sciences, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
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Affiliation as printed
Department of Public Health, Center for Medical Decision Sciences, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
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Affiliation as printed
Department of Public Health, Center for Medical Decision Sciences, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
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Azienda Ospedaliera San Gerardo · University of Milano-Bicocca
Affiliation as printed
Neurointensive Care, San Gerardo Hospital, ASST-Monza, Monza, Italy
School of Medicine and Surgery, University of Milano - Bicocca, Milan, Italy
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University of Antwerp · Antwerp University Hospital
Affiliation as printed
Department of Neurosurgery, Antwerp University Hospital, University of Antwerp, Edegem, Belgium
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University of Cambridge · Addenbrooke's Hospital
Affiliation as printed
Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
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University of Cambridge · Addenbrooke's Hospital
Affiliation as printed
Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
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Affiliation as printed
Section for Perioperative Medicine and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
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Affiliation as printed
Department of Intensive Care Adults, Erasmus MC Stroke Center, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
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Leiden University Medical Center · Erasmus MC
Affiliation as printed
Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
Department of Public Health, Center for Medical Decision Sciences, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
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Innsbruck Medical University · Universität Innsbruck
Affiliation as printed
Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Affiliation as printed
Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK
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Wilco C. Peul Aachen
Leiden University Medical Center · Stichting Haaglanden Medisch Centrum
Affiliation as printed
University Neurosurgical Centre Holland, HMC, HAGA and LUMC, The Hague and Leiden, The Netherlands
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Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
Affiliation as printed
Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
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Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
Affiliation as printed
Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
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Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
Affiliation as printed
Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
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University of Milan · Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
Affiliation as printed
Department of Pathophysiology and Transplants, University of Milan, Milan, Italy
Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
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