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FältnamnIndikatorerMetadata
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003SwePub
008200122s2019 | |||||||||||000 ||eng|
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009oai:prod.swepub.kib.ki.se:141857037
0247 a https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1674712 URI
0247 a https://doi.org/10.1016/S1474-4422(19)30232-72 DOI
0247 a https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-771932 URI
0247 a http://kipublications.ki.se/Default.aspx?queryparsed=id:1418570372 URI
040 a (SwePub)umud (SwePub)orud (SwePub)ki
041 a engb eng
042 9 SwePub
072 7a ref2 swepub-contenttype
072 7a art2 swepub-publicationtype
1001 a Steyerberg., Ewout Wu Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands4 aut
2451 0a Case-mix, care pathways, and outcomes in patients with traumatic brain injury in CENTER-TBI :b a European prospective, multicentre, longitudinal, cohort study
264 1b Elsevier,c 2019
338 a print2 rdacarrier
520 a BACKGROUND: The burden of traumatic brain injury (TBI) poses a large public health and societal problem, but the characteristics of patients and their care pathways in Europe are poorly understood. We aimed to characterise patient case-mix, care pathways, and outcomes of TBI.METHODS: CENTER-TBI is a Europe-based, observational cohort study, consisting of a core study and a registry. Inclusion criteria for the core study were a clinical diagnosis of TBI, presentation fewer than 24 h after injury, and an indication for CT. Patients were differentiated by care pathway and assigned to the emergency room (ER) stratum (patients who were discharged from an emergency room), admission stratum (patients who were admitted to a hospital ward), or intensive care unit (ICU) stratum (patients who were admitted to the ICU). Neuroimages and biospecimens were stored in repositories and outcome was assessed at 6 months after injury. We used the IMPACT core model for estimating the expected mortality and proportion with unfavourable Glasgow Outcome Scale Extended (GOSE) outcomes in patients with moderate or severe TBI (Glasgow Coma Scale [GCS] score ≤12). The core study was registered with ClinicalTrials.gov, number NCT02210221, and with Resource Identification Portal (RRID: SCR_015582).FINDINGS: Data from 4509 patients from 18 countries, collected between Dec 9, 2014, and Dec 17, 2017, were analysed in the core study and from 22 782 patients in the registry. In the core study, 848 (19%) patients were in the ER stratum, 1523 (34%) in the admission stratum, and 2138 (47%) in the ICU stratum. In the ICU stratum, 720 (36%) patients had mild TBI (GCS score 13-15). Compared with the core cohort, the registry had a higher proportion of patients in the ER (9839 [43%]) and admission (8571 [38%]) strata, with more than 95% of patients classified as having mild TBI. Patients in the core study were older than those in previous studies (median age 50 years [IQR 30-66], 1254 [28%] aged >65 years), 462 (11%) had serious comorbidities, 772 (18%) were taking anticoagulant or antiplatelet medication, and alcohol was contributory in 1054 (25%) TBIs. MRI and blood biomarker measurement enhanced characterisation of injury severity and type. Substantial inter-country differences existed in care pathways and practice. Incomplete recovery at 6 months (GOSE <8) was found in 207 (30%) patients in the ER stratum, 665 (53%) in the admission stratum, and 1547 (84%) in the ICU stratum. Among patients with moderate-to-severe TBI in the ICU stratum, 623 (55%) patients had unfavourable outcome at 6 months (GOSE <5), similar to the proportion predicted by the IMPACT prognostic model (observed to expected ratio 1·06 [95% CI 0·97-1·14]), but mortality was lower than expected (0·70 [0·62-0·76]).INTERPRETATION: Patients with TBI who presented to European centres in the core study were older than were those in previous observational studies and often had comorbidities. Overall, most patients presented with mild TBI. The incomplete recovery of many patients should motivate precision medicine research and the identification of best practices to improve these outcomes.FUNDING: European Union 7th Framework Programme, the Hannelore Kohl Stiftung, OneMind, and Integra LifeSciences Corporation.
650 7a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Neurologi0 (SwePub)302072 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Neurology0 (SwePub)302072 hsv//eng
653 a neurokirurgi
653 a Neurosurgery
7001 a Wiegers, Evelineu Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands4 aut
7001 a Sewalt, Charlieu Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands4 aut
7001 a Büki, Andras,d 1966-u Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary; Neurotrauma Research Group, János Szentágothai Research Centre, University of Pécs, Pécs, Hungary4 aut0 (Swepub:oru)asbi
7001 a Citerio, Giuseppeu NeuroIntensive Care, ASST di Monza, Monza, Italy; School of Medicine and Surgery, Università Milano Bicocca, Milan, Italy4 aut
7001 a De Keyser, Véroniqueu Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium4 aut
7001 a Ercole, Ariu Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK4 aut
7001 a Kunzmann, Kevinu MRC Biostatistics Unit, University of Cambridge, Cambridge, UK4 aut
7001 a Lanyon, Lindau International Neuroinformatics Coordinating Facility, Karolinska Institute, Stockholm, Sweden4 aut
7001 a Lecky, Fionau Centre for Urgent and Emergency Care Research, Health Services Research Section, School of Health and Related Research, University of Sheffield, Sheffield, UK4 aut
7001 a Lingsma, Hesteru Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands4 aut
7001 a Manley, Geoffreyu Department of Neurological Surgery, University of California, San Francisco, CA, USA4 aut
7001 a Nelson, Davidu Karolinska Institutet4 aut
7001 a Peul, Wilcou Leiden University Medical Centre and Haaglanden Medical Centre, University Neurosurgical Centre Holland, The Hague and Leiden, Netherlands4 aut
7001 a Stocchetti, Ninou Department of Pathophysiology and Transplantation, Milan University, Milan, Italy; Neuroscience Intensive Care Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy4 aut
7001 a von Steinbüchel, Nicoleu Institute of Medical Psychology and Medical Sociology, Universitätsmedizin Göttingen, Göttingen, Germany4 aut
7001 a Vande Vyvere, Thijsu Department of Radiology, Antwerp University Hospital, Edegem, Belgium; Division of Psychology, University of Stirling, Stirling, UK4 aut
7001 a Verheyden, Janu Icometrix, Leuven, Belgium4 aut
7001 a Wilson, Lindsayu Division of Psychology, University of Stirling, Stirling, UK4 aut
7001 a Maas, Andrew I. R.u Department of Neurosurgery, Antwerp University Hospital, Edegem, Belgium; University of Antwerp, Edegem, Belgium4 aut
7001 a Menon, David K.4 aut
7001 a Brorsson, Camillau Umeå universitet,Anestesiologi och intensivvård4 ctb0 (Swepub:umu)brca0001
7001 a Brorsson, Camillau Umeå universitet,Anestesiologi och intensivvård4 ctb0 (Swepub:umu)brca0001
7001 a Oresic, Matej,d 1967-u Örebro universitet,Institutionen för medicinska vetenskaper0 (Swepub:oru)moc
7102 a Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlandsb Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands4 org
7730 t Lancet Neurologyd : Elsevierg 18:10, s. 923-934q 18:10<923-934x 1474-4422x 1474-4465
8564 8u https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-167471
8564 8u https://doi.org/10.1016/S1474-4422(19)30232-7
8564 8u https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-77193
8564 8u http://kipublications.ki.se/Default.aspx?queryparsed=id:141857037

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