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

Huijben, J.A.; Wiegers, E.J.A.; Lingsma, H.F.; Citerio, G.; Maas, A.I.R.; Menon, D.K.; Ercole, A.; Nelson, D.; van der Jagt, M.; Steyerberg, E.W.; Helbok, R.; Lecky, F.; Peul, W.; Birg, T.; Zoerle, T.; Carbonara, M.; Stocchetti, N.; Akerlund, C.; Amrein, K.; Andelic, N.; Andreassen, L.; Audibert, G.; Azouvi, P.; Azzolini, M.L.; Bartels, R.; Beer, R.; Bellander, B.-.; Benali, H.; Berardino, M.; Beretta, L.; Beqiri, E.; Blaabjerg, M.; Lund, S.B.; Brorsson, C.; Buki, A.; Cabeleira, M.; Caccioppola, A.; Calappi, E.; Calvi, M.R.; Cameron, P.; Lozano, G.C.; Castano-Leon, A.M.; Cavallo, S.; Chevallard, G.; Chieregato, A.; Coburn, M.; Coles, J.; Cooper, J.D.; Correia, M.; Czeiter, E.; Czosnyka, M.; Dahyot-Fizelier, C.; Dark, P.; Dekeyser, V.; Degos, V.; Della Corte, F.; den Boogert, H.; Depreitere, B.; Dilvesi, D.; Dixit, A.; Dreier, J.; Duliere, G.-.; Ezer, E.; Fabricius, M.; Foks, K.; Frisvold, S.; Furmanov, A.; Galanaud, D.; Gantner, D.; Ghuysen, A.; Giga, L.; Golubovic, J.; Gomez, P.A.; Grossi, F.; Gupta, D.; Haitsma, I.; Helseth, E.; Hutchinson, P.J.; Jankowski, S.; Johnson, F.; Karan, M.; Kolias, A.G.; Kondziella, D.; Koraropoulos, E.; Koskinen, L.-.; Kovacs, N.; Kowark, A.; Lagares, A.; Laureys, S.; Ledoux, D.; Lejeune, A.; Lightfoot, R.; Manara, A.; Martino, C.; Marechal, H.; Mattern, J.; Mcmahon, C.; Menovsky, T.; Misset, B.; Muraleedharan, V.; Murray, L.; Negru, A.; Newcombe, V.; Nyiradi, J.; Ortolano, F.; Payen, J.-.; Perlbarg, V.; Persona, P.; Piippo-Karjalainen, A.; Ples, H.; Pomposo, I.; Posti, J.P.; Puybasset, L.; Radoi, A.; Ragauskas, A.; Raj, R.; Rhodes, J.; Richter, S.; Rocka, S.; Roe, C.; Roise, O.; Rosenfeld, J.V.; Rosenlund, C.; Rosenthal, G.; Rossaint, R.; Rossi, S.; Sahuquillo, J.; Sandrod, O.; Sakowitz, O.; Sanchez-Porras, R.; Schirmer-Mikalsen, K.; Schou, R.F.; Smielewski, P.; Sorinola, A.; Stamatakis, E.; Sundstrom, N.; Takala, R.; Tamas, V.; Tamosuitis, T.; Tenovuo, O.; Thomas, M.; Tibboel, D.; Tolias, C.; Trapani, T.; Tudora, C.M.; Vajkoczy, P.; Vallance, S.; Valeinis, E.; Vamos, Z.; Van der Steen, G.; van Wijk, R.P.J.; Vargiolu, A.; Vega, E.; Vik, A.; Vilcinis, R.; Volovici, V.; Vulekovic, P.; Williams, G.; Winzeck, S.; Wolf, S.; Younsi, A.; Zeiler, F.A.; Clusmann, A.Z.H.; Voormolen, D.; van Dijck, J.T.J.M.; van Essen, T.A.

doi:10.1007/s00134-020-05965-z

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.

Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis / J.A. Huijben, E.J.A. Wiegers, H.F. Lingsma, G. Citerio, A.I.R. Maas, D.K. Menon, A. Ercole, D. Nelson, M. van der Jagt, E.W. Steyerberg, R. Helbok, F. Lecky, W. Peul, T. Birg, T. Zoerle, M. Carbonara, N. Stocchetti, C. Akerlund, K. Amrein, N. Andelic, L. Andreassen, G. Audibert, P. Azouvi, M.L. Azzolini, R. Bartels, R. Beer, B.-. Bellander, H. Benali, M. Berardino, L. Beretta, E. Beqiri, M. Blaabjerg, S.B. Lund, C. Brorsson, A. Buki, M. Cabeleira, A. Caccioppola, E. Calappi, M.R. Calvi, P. Cameron, G.C. Lozano, A.M. Castano-Leon, S. Cavallo, G. Chevallard, A. Chieregato, M. Coburn, J. Coles, J.D. Cooper, M. Correia, E. Czeiter, M. Czosnyka, C. Dahyot-Fizelier, P. Dark, V. DeKeyser, V. Degos, F. Della Corte, H. den Boogert, B. Depreitere, D. Dilvesi, A. Dixit, J. Dreier, G.-. Duliere, E. Ezer, M. Fabricius, K. Foks, S. Frisvold, A. Furmanov, D. Galanaud, D. Gantner, A. Ghuysen, L. Giga, J. Golubovic, P.A. Gomez, F. Grossi, D. Gupta, I. Haitsma, E. Helseth, P.J. Hutchinson, S. Jankowski, F. Johnson, M. Karan, A.G. Kolias, D. Kondziella, E. Koraropoulos, L.-. Koskinen, N. Kovacs, A. Kowark, A. Lagares, S. Laureys, D. Ledoux, A. Lejeune, R. Lightfoot, A. Manara, C. Martino, H. Marechal, J. Mattern, C. McMahon, T. Menovsky, B. Misset, V. Muraleedharan, L. Murray, A. Negru, V. Newcombe, J. Nyiradi, F. Ortolano, J.-. Payen, V. Perlbarg, P. Persona, A. Piippo-Karjalainen, H. Ples, I. Pomposo, J.P. Posti, L. Puybasset, A. Radoi, A. Ragauskas, R. Raj, J. Rhodes, S. Richter, S. Rocka, C. Roe, O. Roise, J.V. Rosenfeld, C. Rosenlund, G. Rosenthal, R. Rossaint, S. Rossi, J. Sahuquillo, O. Sandrod, O. Sakowitz, R. Sanchez-Porras, K. Schirmer-Mikalsen, R.F. Schou, P. Smielewski, A. Sorinola, E. Stamatakis, N. Sundstrom, R. Takala, V. Tamas, T. Tamosuitis, O. Tenovuo, M. Thomas, D. Tibboel, C. Tolias, T. Trapani, C.M. Tudora, P. Vajkoczy, S. Vallance, E. Valeinis, Z. Vamos, G. Van der Steen, R.P.J. van Wijk, A. Vargiolu, E. Vega, A. Vik, R. Vilcinis, V. Volovici, P. Vulekovic, G. Williams, S. Winzeck, S. Wolf, A. Younsi, F.A. Zeiler, A.Z.H. Clusmann, D. Voormolen, J.T.J.M. van Dijck, T.A. van Essen. - In: INTENSIVE CARE MEDICINE. - ISSN 0342-4642. - 46:5(2020), pp. 995-1004. [10.1007/s00134-020-05965-z]

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

Huijben J. A.;Wiegers E. J. A.;Lingsma H. F.;Citerio G.;Maas A. I. R.;Menon D. K.;Ercole A.;Nelson D.;van der Jagt M.;Steyerberg E. W.;Helbok R.;Lecky F.;Peul W.;Birg T.;T. Zoerle;Carbonara M.;N. Stocchetti;Akerlund C.;Amrein K.;Andelic N.;Andreassen L.;Audibert G.;Azouvi P.;Azzolini M. L.;Bartels R.;Beer R.;Bellander B. -M.;Benali H.;Berardino M.;Beretta L.;Beqiri E.;Blaabjerg M.;Lund S. B.;Brorsson C.;Buki A.;Cabeleira M.;A. Caccioppola;Calappi E.;Calvi M. R.;Cameron P.;Lozano G. C.;Castano-Leon A. M.;Cavallo S.;G. Chevallard;Chieregato A.;Coburn M.;Coles J.;Cooper J. D.;Correia M.;Czeiter E.;Czosnyka M.;Dahyot-Fizelier C.;Dark P.;DeKeyser V.;Degos V.;Della Corte F.;den Boogert H.;Depreitere B.;Dilvesi D.;Dixit A.;Dreier J.;Duliere G. -L.;Ezer E.;Fabricius M.;Foks K.;Frisvold S.;Furmanov A.;Galanaud D.;Gantner D.;Ghuysen A.;Giga L.;Golubovic J.;Gomez P. A.;Grossi F.;Gupta D.;Haitsma I.;Helseth E.;Hutchinson P. J.;Jankowski S.;Johnson F.;Karan M.;Kolias A. G.;Kondziella D.;Koraropoulos E.;Koskinen L. -O.;Kovacs N.;Kowark A.;Lagares A.;Laureys S.;Ledoux D.;Lejeune A.;Lightfoot R.;Manara A.;Martino C.;Marechal H.;Mattern J.;McMahon C.;Menovsky T.;Misset B.;Muraleedharan V.;Murray L.;Negru A.;Newcombe V.;Nyiradi J.;F. Ortolano;Payen J. -F.;Perlbarg V.;Persona P.;Piippo-Karjalainen A.;Ples H.;Pomposo I.;Posti J. P.;Puybasset L.;Radoi A.;Ragauskas A.;Raj R.;Rhodes J.;Richter S.;Rocka S.;Roe C.;Roise O.;Rosenfeld J. V.;Rosenlund C.;Rosenthal G.;Rossaint R.;Rossi S.;Sahuquillo J.;Sandrod O.;Sakowitz O.;Sanchez-Porras R.;Schirmer-Mikalsen K.;Schou R. F.;Smielewski P.;Sorinola A.;Stamatakis E.;Sundstrom N.;Takala R.;Tamas V.;Tamosuitis T.;Tenovuo O.;Thomas M.;Tibboel D.;Tolias C.;Trapani T.;Tudora C. M.;Vajkoczy P.;Vallance S.;Valeinis E.;Vamos Z.;Van der Steen G.;van Wijk R. P. J.;Vargiolu A.;Vega E.;Vik A.;Vilcinis R.;Volovici V.;Vulekovic P.;Williams G.;Winzeck S.;Wolf S.;Younsi A.;Zeiler F. A.;Clusmann A. Z. H.;Voormolen D.;van Dijck J. T. J. M.;van Essen T. A.

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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	Parole chiave
	
			Intensive care unit; Intracranial pressure; Outcome; Traumatic brain injury
		
	Settori scientifico-disciplinari dell'articolo
	
			Settore MED/41 - Anestesiologia
		
	Data di pubblicazione
	
			2020
		
	Rivista in ANCE
	
			INTENSIVE CARE MEDICINE
		
	DOI
	
			https://dx.doi.org/10.1007/s00134-020-05965-z
		
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			Article (author)
		
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			01 - Articolo su periodico

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