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1. Variation in the practice of tracheal intubation in Europe after traumatic brain injury : a prospective cohort study

Author

Gravesteijn B. Y., Sewalt C. A., Ercole A., Lecky F., Menon D., Steyerberg E. W., Maas A. I. R., Lingsma H. F., Klimek M., Akerlund C., Adams H., Amrein K., Andelic N., Andreassen L., Anke A., Audibert G., Azouvi P., Azzolini M., Bartels R., Beer R., Bellander B., Benali H., Berardino M., Beretta L., Blaabjerg M., Borgen L., Brorsson C., Buki A., Cabeleira M., Caccioppola A., Calappi E., Calvi M., Cameron P., Carbayo L., Carbonara M., Leon A., Chevallard G., Chieregato A., Citerio G., Coburn M., Coles J., Cooper J., Correia M., Cnossen M., Czeiter E., Czosnyka M., Fizelier C., DeKeyser V., Degos V., DellaCorte F., den Boogert H., Depreitere B., Dilvesi D., Dixit A., Donoghue E., 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., Grossi F., Gupta D., Haitsma I., Helbok R., Helseth E., Hutchinson P., Jankowski S., Karan M., Kolias A., Kondziella D., Koskinen L., Kovacs N., Lagares A., Laureys S., Lightfoot R., Lingsma H., Maas A., Manara A., Martino C., Marechal H., Mattern J., McFadyen C., McMahon C., Menovsky T., Mulazzi D., Muraleedharan V., Murray L., Nair N., Negru A., Nelson D., Newcombe V., Noirhomme Q., Nyiradi J., Ortolano F., Payen J., Perlbarg V., Persona P., Peul W., Piippo-Karjalainen A., Ples H., Pomposo I., Posti J., Puybasset L., Radoi A., Ragauskas A., Raj R., Rhodes J., Richter S., Rocka S., Roe C., Roise O., Rosenfeld J., Rosenlund C., Rosenthal G., Rossaint R., Rossi S., Sahuquillo J., Sandro O., Sakowitz O., Porras R., Schirmer-Mikalsen K., SchouRico F., Smielewski P., Sorinola A., Stamatakis E., Kowalk A., Steyerberg E., Stocchetti N., Sundstrom N., Takala R., Tamas V., Tamosuitis T., Tenovuo O., Thomas M., Tibboel D., Tolias C., Trapani T., Tudora C., Vajkoczy P., Vallance S., Valeinis E., Vamos Z., Van der Steen G., vanDijck J., van Essen T., Vanhaudenhuyse A., van Wijk R., Vargiolu A., Vega E., Vik A., Vilcinis R., Volovici V., Voormolen D., Vulekovic P., Williams G., Wolf S., Younsi A., Zeiler F., Ziverte A., Zoerle T., CENTER-TBI Collaborators, Ercole, Ari [0000-0001-8350-8093], Menon, David [0000-0002-3228-9692], Apollo - University of Cambridge Repository, Ragauskas, Arminas, Rocka, Saulius, Tamosuitis, Tomas, Vilcinis, Rimantas, „Wiley' grupė, Gravesteijn, By, Sewalt, Ca, Ercole, A, Lecky, F, Menon, D, Steyerberg, Ew, Maas, A I R, Lingsma, H F, Klimek, M (CENTER-TBI collaborators), Beretta, L, Gravesteijn, B, Sewalt, C, Steyerberg, E, Maas, A, Lingsma, H, Klimek, M, Akerlund, C, Adams, H, Amrein, K, Andelic, N, Andreassen, L, Anke, A, Audibert, G, Azouvi, P, Azzolini, M, Bartels, R, Beer, R, Bellander, B, Benali, H, Berardino, M, Blaabjerg, M, Borgen, L, Brorsson, C, Buki, A, Cabeleira, M, Caccioppola, A, Calappi, E, Calvi, M, Cameron, P, Carbayo, L, Carbonara, M, Leon, A, Chevallard, G, Chieregato, A, Citerio, G, Coburn, M, Coles, J, Cooper, J, Correia, M, Cnossen, M, Czeiter, E, Czosnyka, M, Fizelier, C, Dekeyser, V, Degos, V, Dellacorte, F, den Boogert, H, Depreitere, B, Dilvesi, D, Dixit, A, Donoghue, E, 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, Grossi, F, Gupta, D, Haitsma, I, Helbok, R, Helseth, E, Hutchinson, P, Jankowski, S, Karan, M, Kolias, A, Kondziella, D, Koskinen, L, Kovacs, N, Lagares, A, Laureys, S, Lightfoot, R, Manara, A, Martino, C, Marechal, H, Mattern, J, Mcfadyen, C, Mcmahon, C, Menovsky, T, Mulazzi, D, Muraleedharan, V, Murray, L, Nair, N, Negru, A, Nelson, D, Newcombe, V, Noirhomme, Q, Nyiradi, J, Ortolano, F, Payen, J, Perlbarg, V, Persona, P, Peul, W, Piippo-Karjalainen, A, Ples, H, Pomposo, I, Posti, J, Puybasset, L, Radoi, A, Ragauskas, A, Raj, R, Rhodes, J, Richter, S, Rocka, S, Roe, C, Roise, O, Rosenfeld, J, Rosenlund, C, Rosenthal, G, Rossaint, R, Rossi, S, Sahuquillo, J, Sandro, O, Sakowitz, O, Porras, R, Schirmer-Mikalsen, K, Schourico, F, Smielewski, P, Sorinola, A, Stamatakis, E, Kowalk, A, Stocchetti, N, Sundstrom, N, Takala, R, Tamas, V, Tamosuitis, T, Tenovuo, O, Thomas, M, Tibboel, D, Tolias, C, Trapani, T, Tudora, C, Vajkoczy, P, Vallance, S, Valeinis, E, Vamos, Z, Van der Steen, G, Vandijck, J, van Essen, T, Vanhaudenhuyse, A, van Wijk, R, Vargiolu, A, Vega, E, Vik, A, Vilcinis, R, Volovici, V, Voormolen, D, Vulekovic, P, Williams, G, Wolf, S, Younsi, A, Zeiler, F, Ziverte, A, Zoerle, T, Ročka, Saulius, Tamošuitis, Tomas, Anesthesiology, and Public Health

Subjects
Adult, Male, medicine.medical_specialty, Anestesi och intensivvård, Neurology, Neurologi, Traumatic brain injury, medicine.medical_treatment, Severity of Illness Index, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, 030202 anesthesiology, Brain Injuries, Traumatic, Severity of illness, Intubation, Intratracheal, medicine, Humans, Intubation, tracheal intubation, Prospective Studies, 030212 general & internal medicine, Prospective cohort study, Aged, Anesthesiology and Intensive Care, business.industry, traumatic brain injury, Tracheal intubation, Age Factors, VDP::Medisinske Fag: 700::Basale medisinske, odontologiske og veterinærmedisinske fag: 710, Middle Aged, medicine.disease, VDP::Medical disciplines: 700::Basic medical, dental and veterinary science disciplines: 710, 3. Good health, Europe, Anesthesiology and Pain Medicine, guideline, practice variation, Emergency medicine, Europe, guideline, practice variation, tracheal intubation, traumatic brain injury, Female, Neurosurgery, Human medicine, business, Cohort study
Abstract

Traumatic brain injury patients frequently undergo tracheal intubation. We aimed to assess current intubation practice in Europe and identify variation in practice. We analysed data from patients with traumatic brain injury included in the prospective cohort study collaborative European neurotrauma effectiveness research in traumatic brain injury (CENTER‐TBI) in 45 centres in 16 European countries. We included patients who were transported to hospital by emergency medical services. We used mixed‐effects multinomial regression to quantify the effects on pre‐hospital or in‐hospital tracheal intubation of the following: patient characteristics; injury characteristics; centre; and trauma system characteristics. A total of 3843 patients were included. Of these, 1322 (34%) had their tracheas intubated; 839 (22%) pre‐hospital and 483 (13%) in‐hospital. The fit of the model with only patient characteristics predicting intubation was good (Nagelkerke R2 64%). The probability of tracheal intubation increased with the following: younger age; lower pre‐hospital or emergency department GCS; higher abbreviated injury scale scores (head and neck, thorax and chest, face or abdomen abbreviated injury score); and one or more unreactive pupils. The adjusted median odds ratio for intubation between two randomly chosen centres was 3.1 (95%CI 2.1–4.3) for pre‐hospital intubation, and 2.7 (95%CI 1.9–3.5) for in‐hospital intubation. Furthermore, the presence of an anaesthetist was independently associated with more pre‐hospital intubation (OR 2.9, 95%CI 1.3–6.6), in contrast to the presence of ambulance personnel who are allowed to intubate (OR 0.5, 95%CI 0.3–0.8). In conclusion, patient and injury characteristics are key drivers of tracheal intubation. Between‐centre differences were also substantial. Further studies are needed to improve the evidence base supporting recommendations for tracheal intubation. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Published
2019

2. Incidence, Risk Factors, and Effects on Outcome of Ventilator-Associated Pneumonia in Patients With Traumatic Brain Injury: Analysis of a Large, Multicenter, Prospective, Observational Longitudinal Study

Author

Robba, C, Rebora, P, Banzato, E, Wiegers, Eveline, Stocchetti, N, Menon, DK, Citerio, G, Åkerlund, C, Nelson, D, Amrein, K, Nyirádi, J, Andelic, N, Andreassen, L, Anke, A, Audibert, G, Azouvi, P, Azzolini, ML, Beretta, L, Calvi, MR, Bartels, R, Boogert, HD, Roelofsen-de Beer, R, Helbok, R, Bellander, BM, Benali, H, Degos, V, Galanaud, D, Perlbarg, V, Vanhaudenhuyse, A, Berardino, M, Blaabjerg, M, Lund, SB, Brorsson, C, Buki, A, Czeiter, E, Cabeleira, M, Czosnyka, M, Smielewski, P, Caccioppola, A, Calappi, E, Carbonara, M, Mulazzi, D, Ortolano, F, Zoerle, T, Cameron, P, Gantner, D, Murray, L, Trapani, T, Vallance, S, Lozano, GC, Pomposo, I, Castaño-León, AM, Gomez, PA, Lagares, A, Chevallard, G, Chieregato, A, Coburn, M, Kowark, A, Rossaint, R, Coles, J, Cooper, JD, Correia, M, Dahyot-Fizelier, C, De Keyser, V, Maas, AIR (Arne), Menovsky, T, Nair, N, Van der Steen, G, Della Corte, F, Grossi, F, Depreitere, B, Dilvesi, D, Golubovic, J, Karan, M, Vulekovic, P, Dixit, A, Ercole, A, Koraropoulos, E, Menon, D, Newcombe, V, Richter, S, Stamatakis, E, Williams, G, Winzeck, S, Zeiler, FA, Dreier, J, Dulière, GL, Maréchal, H, Ezer, E, Vámos, Z, Fabricius, M, Kondziella, D, Foks, K, Frisvold, S, Furmanov, A, Rosenthal, G, Ghuysen, A, Giga, L, Valeinis, E, Ziverte, A, Gupta, D, Haitsma, I, Volovici, Victor, Helseth, E, Hutchinson, P J, Kolias, AG, Jankowski, S, Koskinen, LO, Kovács, N, Laureys, S, Noirhomme, Q, Lejeune, A, Vega, E, Lightfoot, R, Steyerberg, Ewout, Lingsma, Hester, Voormolen, Daphne, Manara, A, Thomas, M, Martino, C, Mattern, J, Sakowitz, O, Younsi, A, McMahon, C, Muraleedharan, V, Negru, A, Ples, H, Tudora, CM, Payen, JF, Persona, P, Rossi, S, Peul, W, van Dijck, JTMJ, Essen, TA, van Wijk, RPJ, Piippo-Karjalainen, A, Raj, R, Posti, J P, Tenovuo, O, Puybasset, L, Radoi, A, Sahuquillo, J, Ragauskas, A, Rocka, S, Rhodes, J, Roe, C, Roise, O, Rosenfeld, JV, Rosenlund, C, Sandro, O, Schirmer-Mikalsen, K, Sanchez-Porras, R, Vik, A, Schou, RF, Sorinola, A, Tamás, V, Sundström, N, Takala, R, Tamosuitis, T, Tibboel, Dick, Tolias, C, Vajkoczy, P, Vargiolu, A, Vilcinis, R, Wolf, S, Public Health, Neurosurgery, and Pediatric Surgery

Published
2020

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

Author

Huijben, Jilske A., Wiegers, Eveline J. A., Ercole, Ari, De Keizer, Nicolette F., Maas, Andrew I. R., Steyerberg, Ewout W., Citerio, Giuseppe, Wilson, Lindsay, Polinder, Suzanne, Nieboer, Daan, Menon, David, Lingsma, Hester F., Van Der Jagt, Mathieu, Åkerlund, Cecilia, Amrein, Krisztina, Andelic, Nada, Andreassen, Lasse, Audibert, Gérard, Azouvi, Philippe, Azzolini, Maria Luisa, Bartels, Ronald, Beer, Ronny, Bellander, Bo-Michael, Benali, Habib, Berardino, Maurizio, Beretta, Luigi, Beqiri, Erta, Blaabjerg, Morten, Lund, Stine Borgen, Brorsson, Camilla, Buki, Andras, Cabeleira, Manuel, Caccioppola, Alessio, Calappi, Emiliana, Calvi, Maria Rosa, Cameron, Peter, Lozano, Guillermo Carbayo, Carbonara, Marco, Castaño-León, Ana M., Cavallo, Simona, Chevallard, Giorgio, Chieregato, Arturo, Coburn, Mark, Coles, Jonathan, Cooper, Jamie D., Correia, Marta, Czeiter, Endre, Czosnyka, Marek, Dahyot-Fizelier, Claire, Dark, Paul, De Keyser, Véronique, Degos, Vincent, Corte, Francesco Della, Den Boogert, Hugo, Depreitere, Bart, Dilvesi, Dula, Dixit, Abhishek, Dreier, Jens, Dulière, Guy-Loup, Ezer, Erzsébet, Fabricius, Martin, Foks, Kelly, Frisvold, Shirin, Furmanov, Alex, Galanaud, Damien, Gantner, Dashiell, Ghuysen, Alexandre, Giga, Lelde, Golubovic, Jagos, Gomez, Pedro A., Grossi, Francesca, Gupta, Deepak, Haitsma, Iain, Helbok, Raimund, Helseth, Eirik, Hutchinson, Peter J., Jankowski, Stefan, Johnson, Faye, Karan, Mladen, Kolias, Angelos G., Kondziella, Daniel, Koraropoulos, Evgenios, Koskinen, Lars-Owe, Kovács, Noémi, Kowark, Ana, Lagares, Alfonso, Laureys, Steven, Lecky, Fiona, Ledoux, Didier, Lejeune, Aurelie, Lightfoot, Roger, Manara, Alex, Martino, Costanza, Maréchal, Hugues, Mattern, Julia, McMahon, Catherine, Menovsky, Tomas, Misset, Benoit, Muraleedharan, Visakh, Murray, Lynnette, Negru, Ancuta, Nelson, David, Newcombe, Virginia, Nyirádi, József, Ortolano, Fabrizio, Payen, Jean-François, Perlbarg, Vincent, Persona, Paolo, Peul, Wilco, Piippo-Karjalainen, Anna, Ples, Horia, Pomposo, Inigo, Posti, Jussi P., Puybasset, Louis, Radoi, Andreea, Ragauskas, Arminas, Raj, Rahul, Rhodes, Jonathan, Richter, Sophie, Rocka, Saulius, Roe, Cecilie, Roise, Olav, Rosenfeld, Jeffrey V., Rosenlund, Christina, Rosenthal, Guy, Rossaint, Rolf, Rossi, Sandra, Sahuquillo, Juan, Sandrød, Oddrun, Sakowitz, Oliver, Sanchez-Porras, Renan, Schirmer-Mikalsen, Kari, Schou, Rico Frederik, Smielewski, Peter, Sorinola, Abayomi, Stamatakis, Emmanuel, Stocchetti, Nino, Sundström, Nina, Takala, Riikka, Tamás, Viktória, Tamosuitis, Tomas, Tenovuo, Olli, Thomas, Matt, Tibboel, Dick, Tolias, Christos, Trapani, Tony, Tudora, Cristina Maria, Vajkoczy, Peter, Vallance, Shirley, Valeinis, Egils, Vámos, Zoltán, Van Der Steen, Gregory, Van Dijck, Jeroen T. J. M., Van Essen, Thomas A., Van Wijk, Roel P. J., Vargiolu, Alessia, Vega, Emmanuel, Vik, Anne, Vilcinis, Rimantas, Volovici, Victor, Voormolen, Daphne, Vulekovic, Petar, Williams, Guy, Winzeck, Stefan, Wolf, Stefan, Younsi, Alexander, Zeiler, Frederick A., Ziverte, Agate, Zoerle, Tommaso, Clusmann, Hans, Huijben, J. A., Wiegers, E. J. A., Ercole, A., De Keizer, N. F., Maas, A. I. R., Steyerberg, E. W., Citerio, G., Wilson, L., Polinder, S., Nieboer, D., Menon, D., Lingsma, H. F., Van Der Jagt, M., 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., Caccioppola, A., Calappi, E., Calvi, M. R., Cameron, P., Lozano, G. C., Carbonara, M., 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., De Keyser, V., Degos, V., Corte, F. D., 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., Helbok, R., 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., Lecky, F., 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., Nelson, D., Newcombe, V., Nyiradi, J., Ortolano, F., Payen, J. -F., Perlbarg, V., Persona, P., Peul, W., 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., Stocchetti, N., 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 Dijck, J. T. J. M., Van Essen, T. A., Van Wijk, R. P. J., Vargiolu, A., Vega, E., Vik, A., Vilcinis, R., Volovici, V., Voormolen, D., Vulekovic, P., Williams, G., Winzeck, S., Wolf, S., Younsi, A., Zeiler, F. A., Ziverte, A., Zoerle, T., Clusmann, H., Ragauskas, Arminas, Ročka, Saulius, Tamošuitis, Tomas, Vilcinis, Rimantas, Rocka, Saulius, Tamosuitis, Tomas, „Springer' grupė, Public Health, Neurosurgery, Intensive Care, Huijben, J, Wiegers, E, Ercole, A, de Keizer, N, Maas, A, Steyerberg, E, Citerio, G, Wilson, L, Polinder, S, Nieboer, D, Menon, D, Lingsma, H, van der Jagt, M, Huijben, Jilske A. [0000-0002-2892-5406], Citerio, Giuseppe [0000-0002-5374-3161], Apollo - University of Cambridge Repository, Huijben, Jilske A [0000-0002-2892-5406], Ercole, Ari [0000-0001-8350-8093], Medical Informatics, APH - Methodology, APH - Quality of Care, and APH - Digital Health

Subjects
Adult, Male, benchmarking, intensive care units, quality indicators, quality of health care, traumatic brain injuries, medicine.medical_specialty, Quality management, Traumatic brain injury, Quality indicator, Quality indicators, Critical Care and Intensive Care Medicine, Traumatic brain injuries, 03 medical and health sciences, 0302 clinical medicine, Intensive care, Brain Injuries, Traumatic, medicine, Humans, Intensive care unit, 030212 general & internal medicine, Quality Indicators, Health Care, Intensive care units, business.industry, Data Collection, Research, lcsh:Medical emergencies. Critical care. Intensive care. First aid, Quality measurement, Regression analysis, lcsh:RC86-88.9, Odds ratio, Middle Aged, medicine.disease, Random effects model, Quality Improvement, Europe, Benchmarking, Emergency medicine, Quality of health care, Female, Human medicine, business, 030217 neurology & neurosurgery
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 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).

Published
2020

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

Author

Huijben, Jilske A., Wiegers, Eveline J. A., Lingsma, Hester F., Citerio, Giuseppe, Maas, Andrew I. R., Menon, David K., Ercole, Ari, Nelson, David, van der Jagt, Mathieu, Steyerberg, Ewout W., Helbok, Raimund, Lecky, Fiona, Peul, Wilco, Birg, Tatiana, Zoerle, Tommaso, Carbonara, Marco, Stocchetti, Nino, Åkerlund, Cecilia, Amrein, Krisztina, Andelic, Nada, Andreassen, Lasse, Audibert, Gérard, Azouvi, Philippe, Azzolini, Maria Luisa, Bartels, Ronald, Beer, Ronny, Bellander, Bo-Michael, Benali, Habib, Berardino, Maurizio, Beretta, Luigi, Beqiri, Erta, Blaabjerg, Morten, Lund, Stine Borgen, Brorsson, Camilla, Buki, Andras, Cabeleira, Manuel, Caccioppola, Alessio, Calappi, Emiliana, Calvi, Maria Rosa, Cameron, Peter, Lozano, Guillermo Carbayo, Castaño-León, Ana M., Cavallo, Simona, Chevallard, Giorgio, Chieregato, Arturo, Coburn, Mark, Coles, Jonathan, Cooper, Jamie D., Correia, Marta, Czeiter, Endre, Czosnyka, Marek, Dahyot-Fizelier, Claire, Dark, Paul, DeKeyser, Véronique, Degos, Vincent, Della Corte, Francesco, den Boogert, Hugo, Depreitere, Bart, Dilvesi, Dula, Dixit, Abhishek, Dreier, Jens, Dulière, Guy-Loup, Ezer, Erzsébet, Fabricius, Martin, Foks, Kelly, Frisvold, Shirin, Furmanov, Alex, Galanaud, Damien, Gantner, Dashiell, Ghuysen, Alexandre, Giga, Lelde, Golubovic, Jagos, Gomez, Pedro A., Grossi, Francesca, Gupta, Deepak, Haitsma, Iain, Helseth, Eirik, Hutchinson, Peter J., Jankowski, Stefan, Johnson, Faye, Karan, Mladen, Kolias, AngelosG., Kondziella, Daniel, Koraropoulos, Evgenios, Koskinen, Lars-Owe, Kovács, Noémi, Kowark, Ana, Lagares, Alfonso, Laureys, Steven, Ledoux, Didier, Lejeune, Aurelie, Lightfoot, Roger, Manara, Alex, Martino, Costanza, Maréchal, Hugues, Mattern, Julia, McMahon, Catherine, Menovsky, Tomas, Misset, Benoit, Muraleedharan, Visakh, Murray, Lynnette, Negru, Ancuta, Newcombe, Virginia, Nyirádi, József, Ortolano, Fabrizio, Payen, Jean-François, Perlbarg, Vincent, Persona, Paolo, Piippo-Karjalainen, Anna, Ples, Horia, Pomposo, Inigo, Posti, Jussi P., Puybasset, Louis, Radoi, Andreea, Ragauskas, Arminas, Raj, Rahul, Rhodes, Jonathan, Richter, Sophie, Rocka, Saulius, Roe, Cecilie, Roise, Olav, Rosenfeld, Jeffrey V., Rosenlund, Christina, Rosenthal, Guy, Rossaint, Rolf, Rossi, Sandra, Sahuquillo, Juan, Sandrød, Oddrun, Sakowitz, Oliver, Sanchez-Porras, Renan, Schirmer-Mikalsen, Kari, Schou, Rico Frederik, Smielewski, Peter, Sorinola, Abayomi, Stamatakis, Emmanuel, Sundström, Nina, Takala, Riikka, Tamás, Viktória, Tamosuitis, Tomas, Tenovuo, Olli, Thomas, Matt, Tibboel, Dick, Tolias, Christos, Trapani, Tony, Tudora, CristinaMaria, Vajkoczy, Peter, Vallance, Shirley, Valeinis, Egils, Vámos, Zoltán, Van der Steen, Gregory, van Wijk, Roel P. J., Vargiolu, Alessia, Vega, Emmanuel, Vik, Anne, Vilcinis, Rimantas, Volovici, Victor, Vulekovic, Petar, Williams, Guy, Winzeck, Stefan, Wolf, Stefan, Younsi, Alexander, Zeiler, Frederick A., Clusmann, Agate Ziverte Hans, Voormolen, Daphne, van Dijck, Jeroen T. J. M., van Essen, Thomas A., Ragauskas, Arminas, Ročka, Saulius, Tamošuitis, Tomas, Vilcinis, Rimantas, Tamosuitis, Tomas, „Springer' grupė, CTR-TBI Investigators Participants, Huijben, J, Wiegers, E, Lingsma, H, Citerio, G, Maas, A, Menon, D, Ercole, A, Nelson, D, van der Jagt, M, Steyerberg, E, Helbok, R, Lecky, F, Peul, W, Birg, T, Zoerle, T, Carbonara, M, Stocchetti, N, Huijben, Jilske A. [0000-0002-2892-5406], Apollo - University of Cambridge Repository, Huijben, Jilske A [0000-0002-2892-5406], 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. -M., 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. -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., Ortolano, F., 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., Public Health, and Intensive Care

Subjects
medicine.medical_specialty, Critical Care, Neurologi, Traumatic brain injury, Original, Intracranial pressure, Population, Critical Care and Intensive Care Medicine, Intensive care unit, Traumatic brain injury, Intracranial pressure, Outcome, law.invention, 03 medical and health sciences, 0302 clinical medicine, law, Intensive care, Anesthesiology, Brain Injuries, Traumatic, Medicine, Humans, Glasgow Coma Scale, Intensive care unit, Israel, education, Outcome, education.field_of_study, business.industry, 030208 emergency & critical care medicine, Odds ratio, Middle Aged, medicine.disease, 3. Good health, Europe, Intensive Care Units, 030228 respiratory system, Neurology, Emergency medicine, Human medicine, business
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

Published
2020

8. A population-based study of global outcome after moderate to severe traumatic brain injury in children and adolescents.

Author

Olsen M, Vik A, Lien E, Schirmer-Mikalsen K, Fredriksli O, Follestad T, Sandrød O, Finnanger TG, and Skandsen T

Subjects
Adolescent, Adult, Child, Child, Preschool, Glasgow Coma Scale, Hospitalization, Humans, Infant, Infant, Newborn, Prospective Studies, Trauma Centers, Young Adult, Brain Injuries, Traumatic complications, Brain Injuries, Traumatic epidemiology, Brain Injuries, Traumatic therapy
Abstract

Objective: The primary aim of this study was to evaluate the global outcome longitudinally over 5 years in children and adolescents surviving moderate to severe traumatic brain injury (msTBI) to investigate changes in outcome over time. The secondary aim was to explore how age at the time of injury affected outcome., Methods: All children and adolescents (aged 0-17 years; subdivided into children aged 0-10 years and adolescents aged 11-17 years) with moderate (Glasgow Coma Scale [GCS] score 9-13) or severe (GCS score ≤ 8) TBI who were admitted to a level I trauma center in Norway over a 10-year period (2004-2014) were prospectively included. In addition, young adults (aged 18-24 years) with msTBI were included for comparison. Outcome was assessed with the Glasgow Outcome Scale-Extended (GOS-E) at 6 months, 12 months, and 5 years after injury. The effect of time since injury and age at injury on the probability of good outcome was estimated by the method of generalized estimating equations., Results: A total of 30 children, 39 adolescents, and 97 young adults were included, among which 24 children, 38 adolescents, and 76 young adults survived and were planned for follow-up. In-hospital mortality from TBI was 7% for children, 3% for adolescents, and 18% for young adults. In surviving patients at the 5-year follow-up, good recovery (GOS-E score 7 or 8) was observed in 87% of children and all adolescents with moderate TBI, as well as in 44% of children and 59% of adolescents with severe TBI. No patient remained in a persistent vegetative state. For all patients, the odds for good recovery increased from 6 to 12 months (OR 1.79, 95% CI 1.15-2.80; p = 0.010), although not from 12 months to 5 years (OR 0.98, 95% CI 0.62-1.55; p = 0.940). Children/adolescents (aged 0-17 years) had higher odds for good recovery than young adults (OR 2.86, 95% CI 1.26-6.48; p = 0.012)., Conclusions: In this population-based study of pediatric msTBI, surprisingly high rates of good recovery over 5 years were found, including good recovery for a large majority of children and all adolescents with moderate TBI. Less than half of the children and more than half of the adolescents with severe TBI had good outcomes. The odds for good recovery increased from 6 to 12 months and were higher in children/adolescents (aged 0-17 years) than in young adults.

Published
2022
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9. Intracranial Pressure During Pressure Control and Pressure-Regulated Volume Control Ventilation in Patients with Traumatic Brain Injury: A Randomized Crossover trial.

Author

Schirmer-Mikalsen K, Vik A, Skogvoll E, Moen KG, Solheim O, and Klepstad P

Subjects
Adult, Aged, Brain Injuries, Traumatic diagnosis, Brain Injuries, Traumatic therapy, Cross-Over Studies, Female, Humans, Male, Middle Aged, Positive-Pressure Respiration methods, Young Adult, Brain Injuries, Traumatic physiopathology, Critical Care methods, Intracranial Pressure physiology, Outcome and Process Assessment, Health Care, Respiration, Artificial methods, Tidal Volume physiology
Abstract

Introduction: Mechanical ventilation with control of partial arterial CO2 pressures (PaCO2) is used to treat or stabilize intracranial pressure (ICP) in patients with traumatic brain injury (TBI). Pressure-regulated volume control (PRVC) is a ventilator mode where inspiratory pressures are automatically adjusted to deliver the patient a pre-set stable tidal volume (TV). This may result in a more stable PaCO2 and thus a more stable ICP compared with conventional pressure control (PC) ventilation. The aim of this study was to compare PC and PRVC ventilation in TBI patients with respect to ICP and PaCO2., Methods: This is a randomized crossover trial including eleven patients with a moderate or severe TBI who were mechanically ventilated and had ICP monitoring. Each patient was administered alternating 2-h periods of PC and PRVC ventilation. The outcome variables were ICP and PaCO2., Results: Fifty-two (26 PC, 26 PRVC) study periods were included. Mean ICP was 10.8 mmHg with PC and 10.3 mmHg with PRVC ventilation (p = 0.38). Mean PaCO2 was 36.5 mmHg (4.87 kPa) with PC and 36.1 mmHg (4.81 kPa) with PRVC (p = 0.38). There were less fluctuations in ICP (p = 0.02) and PaCO2 (p = 0.05) with PRVC ventilation., Conclusions: Mean ICP and PaCO2 were similar for PC and PRVC ventilation in TBI patients, but PRVC ventilation resulted in less fluctuation in both ICP and PaCO2. We cannot exclude that the two ventilatory modes would have impact on ICP in patients with higher ICP values; however, the similar PaCO2 observations argue against this.

Published
2016
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10. Moderate traumatic brain injury, acute phase course and deviations in physiological variables: an observational study.

Author

Lund SB, Gjeilo KH, Moen KG, Schirmer-Mikalsen K, Skandsen T, and Vik A

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Brain Injuries, Traumatic physiopathology, Female, Glasgow Coma Scale, Humans, Male, Middle Aged, Retrospective Studies, Tomography, X-Ray Computed, Trauma Severity Indices, Treatment Outcome, Young Adult, Brain Injuries, Traumatic diagnosis, Intracranial Pressure physiology, Monitoring, Physiologic methods, Trauma Centers
Abstract

Background: Patients with moderate traumatic brain injury (TBI) are a heterogeneous group with great variability in clinical course. Guidelines for monitoring and level of care in the acute phase are lacking. The main aim of this observational study was to describe injury severity and the acute phase course during the first three days post-injury in a cohort of patients with moderate TBI. Deviations from defined parameters in selected physiological variables were also studied, based on guidelines for severe TBI during the same period., Methods: During a 5-year period (2004-2009), 119 patients ≥16 years (median age 47 years, range 16-92) with moderate TBI according to the Head Injury Severity Scale were admitted to a Norwegian level 1 trauma centre. Injury-related and acute phase data were collected prospectively. Deviations in six physiological variables were collected retrospectively., Results: Eighty-six percent of the patients had intracranial pathology on CT scan and 61 % had extracranial injuries. Eighty-four percent of all patients were admitted to intensive care units (ICUs) the first day, and 51 % stayed in ICUs ≥3 days. Patients staying in ICUs ≥3 days had lower median Glasgow Coma Scale score; 12 (range 9-15) versus 13 (range 9-15, P = 0.003) and more often extracranial injuries (77 % versus 42 %, P = 0.001) than patients staying in ICU 0-2 days. Most patients staying in ICUs ≥3 days had at least one episode of hypotension (53 %), hypoxia (57 %), hyperthermia (59 %), anaemia (56 %) and hyperglycaemia (65 %), and the proportion of anaemia related to number of measurements was high (33 %)., Conclusion: Most of the moderate TBI patients stayed in an ICU the first day, and half of them stayed in ICUs ≥3 days due to not only intracranial, but also extracranial injuries. Deviations in physiological variables were often seen in this latter group of patients. Lack of guidelines for patients with moderate TBI may leave these deviations uncorrected. We propose that in future research of moderate TBI, patients might be differentiated with regard to their need for monitoring and level of care the first few days post-injury. This could contribute to improvement of acute phase management.

Published
2016
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11. Moderate and severe traumatic brain injury: effect of blood alcohol concentration on Glasgow Coma Scale score and relation to computed tomography findings.

Author

Rundhaug NP, Moen KG, Skandsen T, Schirmer-Mikalsen K, Lund SB, Hara S, and Vik A

Subjects
Adult, Age Factors, Brain Injuries diagnosis, Cohort Studies, Diagnostic Errors, Dose-Response Relationship, Drug, Female, Humans, Male, Middle Aged, Prospective Studies, Tomography, X-Ray Computed, Treatment Outcome, Young Adult, Brain Injuries blood, Brain Injuries diagnostic imaging, Ethanol blood, Glasgow Coma Scale
Abstract

Object: The influence of alcohol is assumed to reduce consciousness in patients with traumatic brain injury (TBI), but research findings are divergent. The aim of this investigation was to study the effects of different levels of blood alcohol concentration (BAC) on the Glasgow Coma Scale (GCS) scores in patients with moderate and severe TBI and to relate the findings to brain injury severity based on the admission CT scan., Methods: In this cohort study, 265 patients (age range 16-70 years) who were admitted to St. Olavs University Hospital with moderate and severe TBI during a 7-year period were prospectively registered. Of these, 217 patients (82%) had measured BAC. Effects of 4 BAC groups on GCS score were examined with ordinal logistic regression analyses, and the GCS scores were inverted to give an OR > 1. The Rotterdam CT score based on admission CT scan was used to adjust for brain injury severity (best score 1 and worst score 6) by stratifying patients into 2 brain injury severity groups (Rotterdam CT scores of 1-3 and 4-6)., Results: Of all patients with measured BAC, 91% had intracranial CT findings and 43% had BAC > 0 mg/dl. The median GCS score was lower in the alcohol-positive patients (6.5, interquartile range [IQR] 4-10) than in the alcohol-negative patients (9, IQR 6-13; p < 0.01). No significant differences were found between alcohol-positive and alcohol-negative patients regarding other injury severity variables. Increasing BAC was a significant predictor of lower GCS score in a dose-dependent manner in age-adjusted analyses, with OR 2.7 (range 1.4-5.0) and 3.2 (range 1.5-6.9) for the 2 highest BAC groups (p < 0.01). Subgroup analyses showed an increasing effect of BAC group on GCS scores in patients with Rotterdam CT scores of 1-3: OR 3.1 (range 1.4-6.6) and 6.7 (range 2.7-16.7) for the 2 highest BAC groups (p < 0.01). No such relationship was found in patients with Rotterdam CT scores of 4-6 (p = 0.14-0.75)., Conclusions: Influence of alcohol significantly reduced the GCS score in a dose-dependent manner in patients with moderate and severe TBI and with Rotterdam CT scores of 1-3. In patients with Rotterdam CT scores of 4-6, and therefore more CT findings indicating increased intracranial pressure, the brain injury itself seemed to overrun the depressing effect of the alcohol on the CNS. This finding is in agreement with the assumption of many clinicians in the emergency situation.

Published
2015
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12. Relationship of "dose" of intracranial hypertension to outcome in severe traumatic brain injury.

Author

Vik A, Nag T, Fredriksli OA, Skandsen T, Moen KG, Schirmer-Mikalsen K, and Manley GT

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Area Under Curve, Child, Child, Preschool, Female, Humans, Infant, Logistic Models, Male, Middle Aged, Monitoring, Physiologic, Brain Injuries diagnostic imaging, Brain Injuries mortality, Brain Injuries physiopathology, Glasgow Coma Scale, Intracranial Hypertension diagnostic imaging, Intracranial Hypertension mortality, Intracranial Hypertension physiopathology, Intracranial Pressure physiology, Tomography, X-Ray Computed
Abstract

Object: It has recently been suggested that the degree of intracranial pressure (ICP) above the treatment goal can be estimated by the area under the curve (AUC) of ICP versus time in patients with severe traumatic brain injury (TBI). The objective of this study was to determine whether the calculated "ICP dose"-the ICP AUC-is related to mortality rate, outcome, and Marshall CT classification., Methods: Of 135 patients (age range 1-82 years) with severe TBI treated during a 5-year period at the authors' institution, 113 patients underwent ICP monitoring (84%). Ninety-three patients with a monitoring time>24 hours were included for analysis of ICP AUC calculated using the trapezoidal method. Computed tomography scans were assessed according to the Marshall TBI classification. Patients with Glasgow Outcome Scale scores at 6 months and >3 years were separated into 2 groups based on outcome., Results: Sixty patients (65%) had ICP values>20 mm Hg, and 12 (13%) developed severe intracranial hypertension and died secondary to herniation. A multiple regression analysis adjusting for Glasgow Coma Scale score, age, pupillary abnormalities and Injury Severity Scale score demonstrated that the ICP AUC was a significant predictor of poor outcome at 6 months (p=0.034) and of death (p=0.035). However, it did not predict long-term outcome (p=0.157). The ICP AUC was significantly higher in patients with Marshall head injury Categories 3 and 4 (24 patients) than in those with Category 2 (23 patients, p=0.025) and Category 5 (46 patients, p=0.021) TBIs using the worst CT scan obtained., Conclusions: The authors found a significant relationship between the dose of ICP, the worst Marshall CT score, and patient outcome, suggesting that the AUC method may be useful in refining and improving the treatment of ICP in patients with TBI.

Published
2008
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