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.
Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis / Huijben, J. A.; Wiegers, E. J. A.; Lingsma, H. F.; Citerio, G.; Maas, A. I. R.; Menon, D. K.; Ercole, A.; Nelson, D.; van der Jagt, M.; Steyerberg, E. W.; Helbok, R.; Lecky, F.; Peul, W.; Birg, T.; Zoerle, T.; Carbonara, M.; Stocchetti, N.; Akerlund, C.; Amrein, K.; Andelic, N.; Andreassen, L.; Audibert, G.; Azouvi, P.; Azzolini, M. L.; Bartels, R.; Beer, R.; Bellander, B. -M.; Benali, H.; Berardino, M.; Beretta, L.; Beqiri, E.; Blaabjerg, M.; Lund, S. B.; Brorsson, C.; Buki, A.; Cabeleira, M.; Caccioppola, A.; Calappi, E.; Calvi, M. R.; Cameron, P.; Lozano, G. C.; Castano-Leon, A. M.; Cavallo, S.; Chevallard, G.; Chieregato, A.; Coburn, M.; Coles, J.; Cooper, J. D.; Correia, M.; Czeiter, E.; Czosnyka, M.; Dahyot-Fizelier, C.; Dark, P.; Dekeyser, V.; Degos, V.; Della Corte, F.; den Boogert, H.; Depreitere, B.; Dilvesi, D.; Dixit, A.; Dreier, J.; Duliere, G. -L.; Ezer, E.; Fabricius, M.; Foks, K.; Frisvold, S.; Furmanov, A.; Galanaud, D.; Gantner, D.; Ghuysen, A.; Giga, L.; Golubovic, J.; Gomez, P. A.; Grossi, F.; Gupta, D.; Haitsma, I.; Helseth, E.; Hutchinson, P. J.; Jankowski, S.; Johnson, F.; Karan, M.; Kolias, A. G.; Kondziella, D.; Koraropoulos, E.; Koskinen, L. -O.; Kovacs, N.; Kowark, A.; Lagares, A.; Laureys, S.; Ledoux, D.; Lejeune, A.; Lightfoot, R.; Manara, A.; Martino, C.; Marechal, H.; Mattern, J.; Mcmahon, C.; Menovsky, T.; Misset, B.; Muraleedharan, V.; Murray, L.; Negru, A.; Newcombe, V.; Nyiradi, J.; Ortolano, F.; Payen, J. -F.; Perlbarg, V.; Persona, P.; Piippo-Karjalainen, A.; Ples, H.; Pomposo, I.; Posti, J. P.; Puybasset, L.; Radoi, A.; Ragauskas, A.; Raj, R.; Rhodes, J.; Richter, S.; Rocka, S.; Roe, C.; Roise, O.; Rosenfeld, J. V.; Rosenlund, C.; Rosenthal, G.; Rossaint, R.; Rossi, S.; Sahuquillo, J.; Sandrod, O.; Sakowitz, O.; Sanchez-Porras, R.; Schirmer-Mikalsen, K.; Schou, R. F.; Smielewski, P.; Sorinola, A.; Stamatakis, E.; Sundstrom, N.; Takala, R.; Tamas, V.; Tamosuitis, T.; Tenovuo, O.; Thomas, M.; Tibboel, D.; Tolias, C.; Trapani, T.; Tudora, C. M.; Vajkoczy, P.; Vallance, S.; Valeinis, E.; Vamos, Z.; Van der Steen, G.; van Wijk, R. P. J.; Vargiolu, A.; Vega, E.; Vik, A.; Vilcinis, R.; Volovici, V.; Vulekovic, P.; Williams, G.; Winzeck, S.; Wolf, S.; Younsi, A.; Zeiler, F. A.; Clusmann, A. Z. H.; Voormolen, D.; van Dijck, J. T. J. M.; van Essen, T. A.. - In: INTENSIVE CARE MEDICINE. - ISSN 0342-4642. - 46:5(2020), pp. 995-1004. [10.1007/s00134-020-05965-z]
Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis
Beretta L.Membro del Collaboration Group
;Martino C.;
2020-01-01
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.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
