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Open Access 01-05-2020 | Central Nervous System Trauma | Original

Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis

Authors: Jilske A. Huijben, Eveline J. A. Wiegers, Hester F. Lingsma, Giuseppe Citerio, Andrew I. R. Maas, David K. Menon, Ari Ercole, David Nelson, Mathieu van der Jagt, Ewout W. Steyerberg, Raimund Helbok, Fiona Lecky, Wilco Peul, Tatiana Birg, Tommaso Zoerle, Marco Carbonara, Nino Stocchetti, CENTER-TBI investigators and participants

Published in: Intensive Care Medicine | Issue 5/2020

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.

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Title: Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis
Authors: Jilske A. Huijben
Eveline J. A. Wiegers
Hester F. Lingsma
Giuseppe Citerio
Andrew I. R. Maas
David K. Menon
Ari Ercole
David Nelson
Mathieu van der Jagt
Ewout W. Steyerberg
Raimund Helbok
Fiona Lecky
Wilco Peul
Tatiana Birg
Tommaso Zoerle
Marco Carbonara
Nino Stocchetti
CENTER-TBI investigators and participants
Publication date: 01-05-2020
Publisher: Springer Berlin Heidelberg
Keywords: Central Nervous System Trauma
Intracranial Hypertension
Care
Published in: Intensive Care Medicine / Issue 5/2020
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-020-05965-z

At a glance: The STEP trials

Springer Medicine

Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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