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Changing care pathw...
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Huijben, Jilske A
(author)
Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe : a CENTER-TBI analysis
- Article/chapterEnglish2020
Publisher, publication year, extent ...
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2020-02-25
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Springer Science and Business Media LLC,2020
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electronicrdacarrier
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LIBRIS-ID:oai:DiVA.org:umu-171374
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https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-171374URI
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https://doi.org/10.1007/s00134-020-05965-zDOI
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http://kipublications.ki.se/Default.aspx?queryparsed=id:143104014URI
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Language:English
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Summary in:English
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Subject category:ref swepub-contenttype
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Subject category:art swepub-publicationtype
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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.
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Wiegers, Eveline J A
(author)
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Lingsma, Hester F
(author)
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Citerio, Giuseppe
(author)
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Maas, Andrew I R
(author)
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Menon, David K
(author)
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Ercole, Ari
(author)
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Nelson, DavidKarolinska Institutet
(author)
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van der Jagt, Mathieu
(author)
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Steyerberg, Ewout W
(author)
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Helbok, Raimund
(author)
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Lecky, Fiona
(author)
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Peul, Wilco
(author)
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Birg, Tatiana
(author)
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Zoerle, Tommaso
(author)
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Carbonara, Marco
(author)
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Stocchetti, Nino
(author)
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Brorsson, CamillaUmeå universitet,Anestesiologi och intensivvård(Swepub:umu)brca0001
(contributor)
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Karolinska InstitutetAnestesiologi och intensivvård
(creator_code:org_t)
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In:Intensive Care Medicine: Springer Science and Business Media LLC46:5, s. 995-10040342-46421432-1238
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Huijben, Jilske ...
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Wiegers, Eveline ...
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Lingsma, Hester ...
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Citerio, Giusepp ...
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Maas, Andrew I R
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Menon, David K
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Ercole, Ari
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Nelson, David
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van der Jagt, Ma ...
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Steyerberg, Ewou ...
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Helbok, Raimund
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Lecky, Fiona
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Peul, Wilco
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Birg, Tatiana
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Zoerle, Tommaso
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Carbonara, Marco
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Stocchetti, Nino
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Brorsson, Camill ...
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- MEDICAL AND HEALTH SCIENCES
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and Neurology
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Intensive Care M ...
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Umeå University
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Karolinska Institutet