Case-mix, care pathways, and outcomes in patients with traumatic brain injury in CENTER-TBI: a European prospective, multicentre, longitudinal, cohort study

CENTER-TBI Participants Investigat, Ewout W. Steyerberg, Eveline Wiegers, Charlie Sewalt, Andras Buki, Giuseppe Citerio, Veronique De Keyser, Ari Ercole, Kevin Kunzmann, Linda Lanyon, Fiona Lecky, Hester Lingsma, Geoffrey Manley, David Nelson, Wilco Peul, Nino Stocchetti, Nicole von Steinbuechel, Thijs Vande Vyvere, Jan Verheyden, Lindsay WilsonAndrew I. R. Maas*, David K. Menon

*Bijbehorende auteur voor dit werk

OnderzoeksoutputAcademicpeer review

67 Citaten (Scopus)

Samenvatting

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

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 22782 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 (8571138%1) 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 128%1 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

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. Copyright (C) 2019 Elsevier Ltd. All rights reserved.

Originele taal-2English
Pagina's (van-tot)923-934
Aantal pagina's12
TijdschriftLancet Neurology
Volume18
Nummer van het tijdschrift10
DOI's
StatusPublished - okt-2019

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