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Critical Care
Published in: Critical Care 1/2020

Open Access 01-12-2020 | Central Nervous System Trauma | Research

Quality indicators for patients with traumatic brain injury in European intensive care units: a CENTER-TBI study

Authors: Jilske A. Huijben, Eveline J. A. Wiegers, Ari Ercole, Nicolette F. de Keizer, Andrew I. R. Maas, Ewout W. Steyerberg, Giuseppe Citerio, Lindsay Wilson, Suzanne Polinder, Daan Nieboer, David Menon, Hester F. Lingsma, Mathieu van der Jagt, the CENTER-TBI investigators and participants for the ICU stratum

Published in: Critical Care | Issue 1/2020

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Abstract

Background

The aim of this study is to validate a previously published consensus-based quality indicator set for the management of patients with traumatic brain injury (TBI) at intensive care units (ICUs) in Europe and to study its potential for quality measurement and improvement.

Methods

Our analysis was based on 2006 adult patients admitted to 54 ICUs between 2014 and 2018, enrolled in the CENTER-TBI study. Indicator scores were calculated as percentage adherence for structure and process indicators and as event rates or median scores for outcome indicators. Feasibility was quantified by the completeness of the variables. Discriminability was determined by the between-centre variation, estimated with a random effect regression model adjusted for case-mix severity and quantified by the median odds ratio (MOR). Statistical uncertainty of outcome indicators was determined by the median number of events per centre, using a cut-off of 10.

Results

A total of 26/42 indicators could be calculated from the CENTER-TBI database. Most quality indicators proved feasible to obtain with more than 70% completeness. Sub-optimal adherence was found for most quality indicators, ranging from 26 to 93% and 20 to 99% for structure and process indicators. Significant (p < 0.001) between-centre variation was found in seven process and five outcome indicators with MORs ranging from 1.51 to 4.14. Statistical uncertainty of outcome indicators was generally high; five out of seven had less than 10 events per centre.

Conclusions

Overall, nine structures, five processes, but none of the outcome indicators showed potential for quality improvement purposes for TBI patients in the ICU. Future research should focus on implementation efforts and continuous reevaluation of quality indicators.

Trial registration

The core study was registered with ClinicalTrials.gov, number NCT02210221, registered on August 06, 2014, with Resource Identification Portal (RRID: SCR_015582).
Appendix
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Literature
1.
Maas AIR, Menon DK, Adelson PD, Andelic N, Bell MJ, Belli A, Bragge P, Brazinova A, Buki A, Chesnut RM, et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neurol. 2017;16(12):987–1048.CrossRef
2.
Haider AH, Hashmi ZG, Gupta S, Zafar SN, David JS, Efron DT, Stevens KA, Zafar H, Schneider EB, Voiglio E, et al. Benchmarking of trauma care worldwide: the potential value of an International Trauma Data Bank (ITDB). World J Surg. 2014;38(8):1882–91.CrossRef
3.
Rhodes A, Moreno RP, Azoulay E, Capuzzo M, Chiche JD, Eddleston J, Endacott R, Ferdinande P, Flaatten H, Guidet B, et al. Prospectively defined indicators to improve the safety and quality of care for critically ill patients: a report from the Task Force on Safety and Quality of the European Society of Intensive Care Medicine (ESICM). Intensive Care Med. 2012;38(4):598–605.CrossRef
4.
O'Reilly GM, Cameron PA, Joshipura M. Global trauma registry mapping: a scoping review. Injury. 2012;43(7):1148–53.CrossRef
5.
Salluh JIF, Soares M, Keegan MT. Understanding intensive care unit benchmarking. Intensive Care Med. 2017;43(11):1703–7.CrossRef
6.
Coleman MP, Forman D, Bryant H, Butler J, Rachet B, Maringe C, Nur U, Tracey E, Coory M, Hatcher J, et al. Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995-2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data. Lancet. 2011;377(9760):127–38.CrossRef
7.
Fox KA, Fitzgerald G, Puymirat E, Huang W, Carruthers K, Simon T, Coste P, Monsegu J, Gabriel Steg P, Danchin N, et al. Should patients with acute coronary disease be stratified for management according to their risk? Derivation, external validation and outcomes using the updated GRACE risk score. BMJ Open. 2014;4(2):e004425.CrossRef
8.
Padman R, McColley SA, Miller DP, Konstan MW, Morgan WJ, Schechter MS, Ren CL, Wagener JS, Investigators, Coordinators of the Epidemiologic Study of Cystic F. Infant care patterns at epidemiologic study of cystic fibrosis sites that achieve superior childhood lung function. Pediatrics. 2007;119(3):e531–7.CrossRef
9.
Donabedian A. The quality of care. How can it be assessed? JAMA. 1988;260(12):1743–8.CrossRef
10.
Volovici V, Ercole A, Citerio G, Stocchetti N, Haitsma IK, Huijben JA, Dirven CMF, van der Jagt M, Steyerberg EW, Nelson D, et al. Intensive care admission criteria for traumatic brain injury patients across Europe. J Crit Care. 2019;49:158–61.CrossRef
11.
Maas AI, Menon DK, Steyerberg EW, Citerio G, Lecky F, Manley GT, Hill S, Legrand V, Sorgner A, Participants C-T, et al. Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI): a prospective longitudinal observational study. Neurosurgery. 2015;76(1):67–80.CrossRef
12.
Steyerberg EW et al. Case-mix, care pathways, and outcomes in patients with traumatic brain injury in CENTER-TBI: a European prospective, multicentre, longitudinal, cohort study. Lancet neurol. 2019;18(10):923-34.
13.
Cnossen MC, Polinder S, Lingsma HF, Maas AI, Menon D, Steyerberg EW, Investigators C-T, Participants. Variation in structure and process of care in traumatic brain injury: provider profiles of European Neurotrauma Centers participating in the CENTER-TBI study. PLoS One. 2016;11(8):e0161367.CrossRef
14.
Fischer C. Quality indcators for hospital care; 2015.
15.
Arts DG, De Keizer NF, Scheffer GJ. Defining and improving data quality in medical registries: a literature review, case study, and generic framework. J Am Med Inform Assoc. 2002;9(6):600–11.CrossRef
16.
van Dishoeck AM, Looman CW, van der Wilden-van Lier EC, Mackenbach JP, Steyerberg EW. Displaying random variation in comparing hospital performance. BMJ Qual Saf. 2011;20(8):651–7.CrossRef
17.
van Overveld LFJ, Takes RP, Braspenning JCC, Baatenburg de Jong RJ, de Boer JP, Brouns JJA, Bun RJ, Dik EA, van Dijk BAC, van Es RJJ. Variation in integrated head and neck cancer care: impact of patient and hospital characteristics. J Natl Compr Cancer Netw. 2018;16(12):1491–8.
18.
Lingsma HF, Steyerberg EW, Eijkemans MJ, Dippel DW, Scholte Op Reimer WJ, Van Houwelingen HC, Netherlands Stroke Survey I. Comparing and ranking hospitals based on outcome: results from The Netherlands Stroke Survey. QJM. 2010;103(2):99–108.CrossRef
19.
van Dishoeck AM, Lingsma HF, Mackenbach JP, Steyerberg EW. Random variation and rankability of hospitals using outcome indicators. BMJ Qual Saf. 2011;20(10):869–74.CrossRef
20.
Merlo J, Chaix B, Ohlsson H, Beckman A, Johnell K, Hjerpe P, Rastam L, Larsen K. A brief conceptual tutorial of multilevel analysis in social epidemiology: using measures of clustering in multilevel logistic regression to investigate contextual phenomena. J Epidemiol Community Health. 2006;60(4):290–7.CrossRef
21.
Steyerberg EW, Mushkudiani N, Perel P, Butcher I, Lu J, McHugh GS, Murray GD, Marmarou A, Roberts I, Habbema JD, et al. Predicting outcome after traumatic brain injury: development and international validation of prognostic scores based on admission characteristics. PLoS Med. 2008;5(8):e165 discussion e165.CrossRef
22.
Stram DO, Lee JW. Variance components testing in the longitudinal mixed effects model. Biometrics. 1994;50(4):1171–7.CrossRef
23.
Buuren S. van, Groothuis-Oudshoorn K. Mice: Multivariate Imputation by Chained Equations in R. J Stat Software 45. 2011. p. 1-68.
24.
Cnossen MC, Polinder S, Andriessen TM, van der Naalt J, Haitsma I, Horn J, Franschman G, Vos PE, Steyerberg EW, Lingsma H. Causes and consequences of treatment variation in moderate and severe traumatic brain injury: a multicenter study. Crit Care Med. 2017;45(4):660–9.CrossRef
25.
Bulger EM, Nathens AB, Rivara FP, Moore M, MacKenzie EJ, Jurkovich GJ, Brain Trauma Foundation. Management of severe head injury: institutional variations in care and effect on outcome. Crit Care Med. 2002;30(8):1870–6.
26.
Alali AS, Fowler RA, Mainprize TG, Scales DC, Kiss A, de Mestral C, Ray JG, Nathens AB. Intracranial pressure monitoring in severe traumatic brain injury: results from the American College of Surgeons Trauma Quality Improvement Program. J Neurotrauma. 2013;30(20):1737–46.CrossRef
27.
Vavilala MS, Kernic MA, Wang J, Kannan N, Mink RB, Wainwright MS, Groner JI, Bell MJ, Giza CC, Zatzick DF, et al. Acute care clinical indicators associated with discharge outcomes in children with severe traumatic brain injury. Crit Care Med. 2014;42(10):2258–66.CrossRef
28.
de Carvalho AGR, de Moraes APP, Tanaka LMS, Gomes RV, da Silva AAM. Quality in intensive care units: proposal of an assessment instrument. BMC Res Notes. 2017;10(1):222.CrossRef
29.
Najjar-Pellet J, Jonquet O, Jambou P, Fabry J. Quality assessment in intensive care units: proposal for a scoring system in terms of structure and process. Intensive Care Med. 2008;34(2):278–85.CrossRef
30.
Cai L, Zhu Y. The challenges of data quality and data quality assessment in the big data era. Data Sci J. 2015;14:2.CrossRef
31.
Stocchetti N, Penny KI, Dearden M, Braakman R, Cohadon F, Iannotti F, Lapierre F, Karimi A, Maas A Jr, Murray GD, et al. Intensive care management of head-injured patients in Europe: a survey from the European brain injury consortium. Intensive Care Med. 2001;27(2):400–6.CrossRef
32.
Metadata
Title
Quality indicators for patients with traumatic brain injury in European intensive care units: a CENTER-TBI study
Authors
Jilske A. Huijben
Eveline J. A. Wiegers
Ari Ercole
Nicolette F. de Keizer
Andrew I. R. Maas
Ewout W. Steyerberg
Giuseppe Citerio
Lindsay Wilson
Suzanne Polinder
Daan Nieboer
David Menon
Hester F. Lingsma
Mathieu van der Jagt
the CENTER-TBI investigators and participants for the ICU stratum
Publication date
01-12-2020
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2020
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-020-2791-0

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