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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 ...

  • 2020-02-25
  • Springer Science and Business Media LLC,2020
  • electronicrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:umu-171374
  • https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-171374URI
  • https://doi.org/10.1007/s00134-020-05965-zDOI
  • http://kipublications.ki.se/Default.aspx?queryparsed=id:143104014URI

Supplementary language notes

  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • 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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Added entries (persons, corporate bodies, meetings, titles ...)

  • Wiegers, Eveline J A (author)
  • Lingsma, Hester F (author)
  • Citerio, Giuseppe (author)
  • Maas, Andrew I R (author)
  • Menon, David K (author)
  • Ercole, Ari (author)
  • Nelson, DavidKarolinska Institutet (author)
  • van der Jagt, Mathieu (author)
  • Steyerberg, Ewout W (author)
  • Helbok, Raimund (author)
  • Lecky, Fiona (author)
  • Peul, Wilco (author)
  • Birg, Tatiana (author)
  • Zoerle, Tommaso (author)
  • Carbonara, Marco (author)
  • Stocchetti, Nino (author)
  • Brorsson, CamillaUmeå universitet,Anestesiologi och intensivvård(Swepub:umu)brca0001 (contributor)
  • Karolinska InstitutetAnestesiologi och intensivvård (creator_code:org_t)

Related titles

  • In:Intensive Care Medicine: Springer Science and Business Media LLC46:5, s. 995-10040342-46421432-1238

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