12 results on '"Huijben, Jilske A."'
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2. Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis
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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
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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
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- 2020
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3. Quality indicators for patients with traumatic brain injury in European intensive care units: A CENTER-TBI study
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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
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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).
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- 2020
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4. Use and impact of high intensity treatments in patients with traumatic brain injury across Europe: a CENTER-TBI analysis
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Huijben, Jilske A., Dixit, Abhishek, Stocchetti, Nino, Maas, Andrew I. R., Lingsma, Hester F., van der Jagt, Mathieu, Nelson, David, Citerio, Giuseppe, Wilson, Lindsay, Menon, David K., Ercole, Ari, Andelic, Nada, Andreassen, Lasse, Anke, Audny Gabriele Wagner, Frisvold, Shirin, Helseth, Eirik, Røe, Cecilie, Røise, Olav, Skandsen, Toril, Vik, Anne, Åkerlund, Cecilia, Amrein, Krisztina, Antoni, Anna, Audibert, Gerard, Azouvi, Philippe, Azzolini, Maria luisa, Bartels, Ronald, Barzo, Pal, Beauvais, Romuald, Beer, Ronny, Bellander, Bo-michael, Belli, Antonio, Benali, Habib, Berardino, Maurizio, Beretta, Luigi, Blaabjerg, Morten, Bragge, Peter, Brazinova, Alexandra, Brinck, Vibeke, Brooker, Joanne, Brorsson, Camilla, Buki, Andras, Bullinger, Monika, Cabeleira, Manuel, Caccioppola, Alessio, Calappi, Emiliana, Calvi, Maria rosa, Cameron, Peter, Lozano, Guillermo carbayo, Carbonara, Marco, Chevallard, Giorgio, Chieregato, Arturo, Cnossen, Maryse, Coburn, Mark, Ragauskas, Arminas, Ročka, Saulius, Tamošuitis, Tomas, Vilcinis, Rimantas, Huijben, Jilske A [0000-0002-2892-5406], Apollo - University of Cambridge Repository, Rocka, Saulius, Tamosuitis, Tomas, „Springer Nature' grupė, Huijben, J, Dixit, A, Stocchetti, N, Maas, A, Lingsma, H, van der Jagt, M, Nelson, D, Citerio, G, Wilson, L, Menon, D, Ercole, A, CTR-TBI Investigators Participants, Public Health, Intensive Care, Huijben, J. A., Dixit, A., Stocchetti, N., Maas, A. I. R., Lingsma, H. F., van der Jagt, M., Nelson, D., Citerio, G., Wilson, L., Menon, D. K., Ercole A., (CENTER-TBI investigators and participants), and Beretta, Luigi
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Male ,Barbiturate ,Neurologi ,medicine.medical_treatment ,Hypothermia ,Critical Care and Intensive Care Medicine ,Logistic regression ,Brain herniation ,0302 clinical medicine ,Traumatic brain injury ,Brain Injuries, Traumatic ,Hyperventilation ,030212 general & internal medicine ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,hemic and immune systems ,Middle Aged ,Europe ,Intensive Care Units ,Neurology ,Decompressive craniectomy ,Female ,medicine.symptom ,Adult ,medicine.medical_specialty ,Medication Therapy Management ,chemical and pharmacologic phenomena ,03 medical and health sciences ,Intensive care ,Internal medicine ,medicine ,Humans ,In patient ,Aged ,business.industry ,Research ,barbiturates ,decompressive craniectomy ,hyperventilation ,hypothermia ,therapy intensity level ,traumatic brain injury ,lcsh:RC86-88.9 ,Therapy intensity level ,medicine.disease ,Logistic Models ,Barbiturates ,Human medicine ,Intracranial Hypertension ,business ,030217 neurology & neurosurgery - Abstract
Purpose To study variation in, and clinical impact of high Therapy Intensity Level (TIL) treatments for elevated intracranial pressure (ICP) in patients with traumatic brain injury (TBI) across European Intensive Care Units (ICUs). Methods We studied high TIL treatments (metabolic suppression, hypothermia (2 Results 313 of 758 patients from 52 European centres (41%) received at least one high TIL treatment with significant variation between centres (median odds ratio = 2.26). Patients often transiently received high TIL therapies without escalation from lower tier treatments. 38% of patients with high TIL treatment had favourable outcomes (GOSE ≥ 5). The use of high TIL treatment was not significantly associated with worse outcome (285 matched pairs, OR 1.4, 95% CI [1.0–2.0]). However, a sensitivity analysis excluding high TIL treatments at day 1 or use of metabolic suppression at any day did reveal a statistically significant association with worse outcome. Conclusion Substantial between-centre variation in use of high TIL treatments for TBI was found and treatment escalation to higher TIL treatments were often not preceded by more conventional lower TIL treatments. The significant association between high TIL treatments after day 1 and worse outcomes may reflect aggressive use or unmeasured confounders or inappropriate escalation strategies. Take home message Substantial variation was found in the use of highly intensive ICP-lowering treatments across European ICUs and a stepwise escalation strategy from lower to higher intensity level therapy is often lacking. Further research is necessary to study the impact of high therapy intensity treatments. Trial registration The core study was registered with ClinicalTrials.gov, number NCT02210221, registered 08/06/2014, https://clinicaltrials.gov/ct2/show/NCT02210221?id=NCT02210221&draw=1&rank=1 and with Resource Identification Portal (RRID: SCR_015582).
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- 2021
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5. Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury
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Cnossen, Maryse C., Huijben, Jilske A., van der Jagt, Mathieu, Volovici, Victor, van Essen, Thomas, Polinder, Suzanne, Nelson, David, Ercole, Ari, Stocchetti, Nino, Citerio, Giuseppe, Peul, Wilco C., Maas, Andrew I. R., Menon, David, Steyerberg, Ewout W., Lingsma, Hester F., Adams, Hadie, Alessandro, Masala, Allanson, Judith, Amrein, Krisztina, Andaluz, Norberto, Andelic, Nada, Andrea, Nanni, Andreassen, Lasse, Anke, Audny, Antoni, Anna, Ardon, Hilko, Audibert, Gérard, Auslands, Kaspars, Azouvi, Philippe, Baciu, Camelia, Bacon, Andrew, Badenes, Rafael, Baglin, Trevor, Bartels, Ronald, Barzó, Pál, Bauerfeind, Ursula, Beer, Ronny, Belda, Francisco Javier, Bellander, Bo-Michael, Belli, Antonio, Bellier, Rémy, Benali, Habib, Benard, Thierry, Berardino, Maurizio, Beretta, Luigi, Beynon, Christopher, Bilotta, Federico, Binder, Harald, Biqiri, Erta, Blaabjerg, Morten, Lund, Stine Borgen, Bouzat, Pierre, Bragge, Peter, Brazinova, Alexandra, Brehar, Felix, Brorsson, Camilla, Buki, Andras, Bullinger, Monika, Bucková, Veronika, Calappi, Emiliana, Cameron, Peter, Carbayo, Lozano Guillermo, Carise, Elsa, Carpenter, Keri, Castaño-León, Ana M., Causin, Francesco, Chevallard, Giorgio, Chieregato, Arturo, Cooper, M., Coburn, Mark, Coles, Jonathan, Cooper, Jamie D., Correia, Marta, Covic, Amra, Curry, Nicola, Czeiter, Endre, Czosnyka, Marek, Dahyot-Fizelier, Claire, Damas, François, Damas, Pierre, Dawes, Helen, De Keyser, Véronique, Corte, Francesco Della, Depreitere, Bart, Ding, Shenghao, Dippel, Diederik, Dizdarevic, Kemal, Dulière, Guy-Loup, Dzeko, Adelaida, Eapen, George, Engemann, Heiko, Esser, Patrick, Ezer, Erzsébet, Fabricius, Martin, Feigin, Valery L., Feng, Junfeng, Foks, Kelly, Fossi, Francesca, Francony, Gilles, Frantzén, Janek, Freo, Ulderico, Frisvold, Shirin, Furmanov, Alex, Gagliardo, Pablo, Galanaud, Damien, Gao, Guoyi, Geleijns, Karin, Ghuysen, Alexandre, Giraud, Benoit, Glocker, Ben, Gomez, Pedro A., Grossi, Francesca, Gruen, Russell L., Gupta, Deepak, Haagsma, Juanita A., Hadzic, Ermin, Haitsma, Iain, Hartings, Jed A., Helbok, Raimund, Helseth, Eirik, Hertle, Daniel, Hill, Sean, Hoedemaekers, Astrid, Hoefer, Stefan, Hutchinson, Peter J., Håberg, Kristine Asta, Jacobs, Bram, Janciak, Ivan, Janssens, Koen, Jiang, Ji-Yao, Jones, Kelly, Kalala, Jean-Pierre, Kamnitsas, Konstantinos, Karan, Mladen, Karau, Jana, Katila, Ari, Kaukonen, Maija, Keeling, David, Kerforne, Thomas, Ketharanathan, Naomi, Kettunen, Johannes, Kivisaari, Riku, Kolias, Angelos G., Kolumbán, Bálint, Kompanje, Erwin, Kondziella, Daniel, Koskinen, Lars-Owe, Kovács, Noémi, Kálovits, Ferenc, Lagares, Alfonso, Lanyon, Linda, Laureys, Steven, Lauritzen, Martin, Lecky, Fiona, Ledig, Christian, Lefering, Rolf, Legrand, Valerie, Lei, Jin, Levi, Leon, Lightfoot, Roger, Loeckx, Dirk, Lozano, Angels, Luddington, Roger, Luijten-Arts, Chantal, Macdonald, Stephen, Macfayden, Charles, Maegele, Marc, Majdan, Marek, Major, Sebastian, Manara, Alex, Manhes, Pauline, Manley, Geoffrey, Martin, Didier, Martino, Costanza, Maruenda, Armando, Maréchal, Hugues, Mastelova, Dagmara, Mattern, Julia, Mcmahon, Catherine, Melegh, Béla, Menovsky, Tomas, Morganti-Kossmann, Cristina, Mulazzi, Davide, Mutschler, Manuel, Mühlan, Holger, Negru, Ancuta, Neugebauer, Eddy, Newcombe, Virginia, Noirhomme, Quentin, Nyirádi, József, Oddo, Mauro, Oldenbeuving, Annemarie, Oresic, Matej, Ortolano, Fabrizio, Palotie, Aarno, Parizel, Paul M., Patruno, Adriana, Payen, Jean-François, Perera, Natascha, Perlbarg, Vincent, Persona, Paolo, Pichon, Nicolas, Piilgaard, Henning, Piippo, Anna, Floury, Sébastien Pili, Pirinen, Matti, Ples, Horia, Pomposo, Inigo, Psota, Marek, Pullens, Pim, Puybasset, Louis, Ragauskas, Arminas, Raj, Rahul, Rambadagalla, Malinka, Rehorcíková, Veronika, Rhodes, Jonathan, Richardson, Sylvia, Ripatti, Samuli, Rocka, Saulius, Rodier, Nicolas, Roe, Cecilie, Roise, Olav, Roks, Gerwin, Romegoux, Pauline, Rosand, Jonathan, Rosenfeld, Jeffrey, Rosenlund, Christina, Rosenthal, Guy, Rossaint, Rolf, Rossi, Sandra, Rostalski, Tim, Rueckert, Daniel, de Ruiz, Arcaute Felix, Rusnák, Martin, Sacchi, Marco, Sahakian, Barbara, Sahuquillo, Juan, Sakowitz, Oliver, Sala, Francesca, Sanchez-Pena, Paola, Sanchez-Porras, Renan, Sandor, Janos, Santos, Edgar, Sasse, Nadine, Sasu, Luminita, Savo, Davide, Schipper, Inger, Schlößer, Barbara, Schmidt, Silke, Schneider, Annette, Schoechl, Herbert, Schoonman, Guus, Rico, Frederik Schou, Schwendenwein, Elisabeth, Schöll, Michael, Sir, Özcan, Skandsen, Toril, Smakman, Lidwien, Smeets, Dirk, Smielewski, Peter, Sorinola, Abayomi, Stamatakis, Emmanuel, Stanworth, Simon, Stegemann, Katrin, Steinbüchel, Nicole, Stevens, Robert, Stewart, William, Sundström, Nina, Synnot, Anneliese, Szabó, József, Söderberg, Jeannette, Taccone, Fabio Silvio, Tamás, Viktória, Tanskanen, Päivi, Tascu, Alexandru, Taylor, Mark Steven, Ao Braden, Te, Tenovuo, Olli, Teodorani, Guido, Theadom, Alice, Thomas, Matt, Tibboel, Dick, Tolias, Christos, Tshibanda, Jean-Flory Luaba, Tudora, Cristina Maria, Vajkoczy, Peter, Valeinis, Egils, Hecke, Wim Van, Praag, Dominique Van, Dirk, Van Roost, Vlierberghe, Eline Van, Vyvere, Thijs vande, Vanhaudenhuyse, Audrey, Vargiolu, Alessia, Vega, Emmanuel, Verheyden, Jan, Vespa, Paul M., Vik, Anne, Vilcinis, Rimantas, Vizzino, Giacinta, Vleggeert-Lankamp, Carmen, Vulekovic, Peter, Vámos, Zoltán, Wade, Derick, Wang, Kevin K. W., Wang, Lei, Wildschut, Eno, Williams, Guy, Willumsen, Lisette, Wilson, Adam, Wilson, Lindsay, Winkler, Maren K. L., Ylén, Peter, Younsi, Alexander, Zaaroor, Menashe, Zhang, Zhiqun, Zheng, Zelong, Zumbo, Fabrizio, de Lange, Stefanie, de Ruiter, Godard C. W., den Boogert, Hugo, van Dijck, Jeroen, van Heugten, Caroline, van der Naalt, Joukje, Cnossen, Maryse C., Huijben, Jilske A., Van der Jagt, Mathieu, Volovici, Victor, Van Essen, Thoma, Polinder, Suzanne, Nelson, David, Ercole, Ari, Stocchetti, Nino, Citerio, Giuseppe, Peul, Wilco C., Maas, Andrew I. R., Menon, David, Steyerberg, Ewout W., Lingsma, Hester F., on behalf of the CENTER-TBI, Investigator, Beretta, Luigi, Cnossen, M, Huijben, J, van der Jagt, M, Volovici, V, van Essen, T, Polinder, S, Nelson, D, Ercole, A, Stocchetti, N, Citerio, G, Peul, W, Maas, A, Menon, D, Steyerberg, E, Lingsma, H, Molecular Neuroscience and Ageing Research (MOLAR), Psychiatrie & Neuropsychologie, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, Commission of the European Communities, CENTER-TBI Investigators, Medical Informatics, Public and occupational health, Ragauskas, Arminas, Ročka, Saulius, Vilcinis, Rimantas, Public Health, Intensive Care, Neurosurgery, CENTER-TBI investigators, Adams, H., Alessandro, M., Allanson, J., Amrein, K., Andaluz, N., Andelic, N., Andrea, N., Andreassen, L., Anke, A., Antoni, A., Ardon, H., Audibert, G., Auslands, K., Azouvi, P., Baciu, C., Bacon, A., Badenes, R., Baglin, T., Bartels, R., Barzó, P., Bauerfeind, U., Beer, R., Belda, F.J., Bellander, B.M., Belli, A., Bellier, R., Benali, H., Benard, T., Berardino, M., Beretta, L., Beynon, C., Bilotta, F., Binder, H., Biqiri, E., Blaabjerg, M., Borgen, L.S., Bouzat, P., Bragge, P., Brazinova, A., Brehar, F., Brorsson, C., Buki, A., Bullinger, M., Bučková, V., Calappi, E., Cameron, P., Lozano, G.C., Carise, E., Carpenter, K., Castaño-León, A.M., Causin, F., Chevallard, G., Chieregato, A., Citerio, G., Cnossen, M., Coburn, M., Coles, J., Cooper, J.D., Correia, M., Covic, A., Curry, N., Czeiter, E., Czosnyka, M., Dahyot-Fizelier, C., Damas, F., Damas, P., Dawes, H., De Keyser, V., Corte, F.D., Depreitere, B., Ding, S., Dippel, D., Dizdarevic, K., Dulière, G.L., Dzeko, A., Eapen, G., Engemann, H., Ercole, A., Esser, P., Ezer, E., Fabricius, M., Feigin, V.L., Feng, J., Foks, K., Fossi, F., Francony, G., Frantzén, J., Freo, U., Frisvold, S., Furmanov, A., Gagliardo, P., Galanaud, D., Gao, G., Geleijns, K., Ghuysen, A., Giraud, B., Glocker, B., Gomez, P.A., Grossi, F., Gruen, R.L., Gupta, D., Haagsma, J.A., Hadzic, E., Haitsma, I., Hartings, J.A., Helbok, R., Helseth, E., Hertle, D., Hill, S., Hoedemaekers, A., Hoefer, S., Hutchinson, P.J., Håberg, A.K., Jacobs, B., Janciak, I., Janssens, K., Jiang, J.Y., Jones, K., Kalala, J.P., Kamnitsas, K., Karan, M., Karau, J., Katila, A., Kaukonen, M., Keeling, D., Kerforne, T., Ketharanathan, N., Kettunen, J., Kivisaari, R., Kolias, A.G., Kolumbán, B., Kompanje, E., Kondziella, D., Koskinen, L.O., Kovács, N., Kálovits, F., Lagares, A., Lanyon, L., Laureys, S., Lauritzen, M., Lecky, F., Ledig, C., Lefering, R., Legrand, V., Lei, J., Levi, L., Lightfoot, R., Lingsma, H., Loeckx, D., Lozano, A., Luddington, R., Luijten-Arts, C., Andrew, IRM, MacDonald, S., MacFayden, C., Maegele, M., Majdan, M., Major, S., Manara, A., Manhes, P., Manley, G., Martin, D., Martino, C., Maruenda, A., Maréchal, H., Mastelova, D., Mattern, J., McMahon, C., Melegh, B., Menon, D., Menovsky, T., Morganti-Kossmann, C., Mulazzi, D., Mutschler, M., Mühlan, H., Negru, A., Nelson, D., Neugebauer, E., Newcombe, V., Noirhomme, Q., Nyirádi, J., Oddo, M., Oldenbeuving, A., Oresic, M., Ortolano, F., Palotie, A., Parizel, P.M., Patruno, A., Payen, J.F., Perera, N., Perlbarg, V., Persona, P., Peul, W., Pichon, N., Piilgaard, H., Piippo, A., Floury, S.P., Pirinen, M., Ples, H., Polinder, S., Pomposo, I., Psota, M., Pullens, P., Puybasset, L., Ragauskas, A., Raj, R., Rambadagalla, M., Rehorčíková, V., Rhodes, J., Richardson, S., Ripatti, S., Rocka, S., Rodier, N., Roe, C., Roise, O., Roks, G., Romegoux, P., Rosand, J., Rosenfeld, J., Rosenlund, C., Rosenthal, G., Rossaint, R., Rossi, S., Rostalski, T., Rueckert, D., de Arcaute, F.R., Rusnák, M., Sacchi, M., Sahakian, B., Sahuquillo, J., Sakowitz, O., Sala, F., Sanchez-Pena, P., Sanchez-Porras, R., Sandor, J., Santos, E., Sasse, N., Sasu, L., Savo, D., Schipper, I., Schlößer, B., Schmidt, S., Schneider, A., Schoechl, H., Schoonman, G., Schou, R.F., Schwendenwein, E., Schöll, M., Sir, Ö., Skandsen, T., Smakman, L., Smeets, D., Smielewski, P., Sorinola, A., Stamatakis, E., Stanworth, S., Stegemann, K., Steinbüchel, N., Stevens, R., Stewart, W., Steyerberg, E.W., Stocchetti, N., Sundström, N., Synnot, A., Szabó, J., Söderberg, J., Taccone, F.S., Tamás, V., Tanskanen, P., Tascu, A., Taylor, M.S., Te Ao, B., Tenovuo, O., Teodorani, G., Theadom, A., Thomas, M., Tibboel, D., Tolias, C., Tshibanda, J.L., Tudora, C.M., Vajkoczy, P., Valeinis, E., Van Hecke, W., Van Praag, D., Van Roost, D., Van Vlierberghe, E., Vyvere, T.V., Vanhaudenhuyse, A., Vargiolu, A., Vega, E., Verheyden, J., Vespa, P.M., Vik, A., Vilcinis, R., Vizzino, G., Vleggeert-Lankamp, C., Volovici, V., Vulekovic, P., Vámos, Z., Wade, D., Wang, KKW, Wang, L., Wildschut, E., Williams, G., Willumsen, L., Wilson, A., Wilson, L., Winkler, MKL, Ylén, P., Younsi, A., Zaaroor, M., Zhang, Z., Zheng, Z., Zumbo, F., de Lange, S., de Ruiter, GCW, den Boogert, H., van Dijck, J., van Essen, T.A., van Heugten, C., van der Jagt, M., van der Naalt, J., Rocka, Saulius, „Springer' grupė, Apollo - University of Cambridge Repository, Centre of Excellence in Complex Disease Genetics, Department of Mathematics and Statistics, Institute for Molecular Medicine Finland, Biostatistics Helsinki, Aarno Palotie / Principal Investigator, University of Helsinki, Neurokirurgian yksikkö, Clinicum, Samuli Olli Ripatti / Principal Investigator, Complex Disease Genetics, Genomics of Neurological and Neuropsychiatric Disorders, and Statistical and population genetics
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Neurology ,Letter ,IMPACT ,Critical Care and Intensive Care Medicine ,Intracranial hypertension ,0302 clinical medicine ,Traumatic brain injury ,Clinical Protocols ,Trauma Centers ,Surveys and Questionnaires ,Brain Injuries, Traumatic ,Medicine and Health Sciences ,Longitudinal Studies ,Prospective Studies ,Prospective cohort study ,Comparative effectiveness research ,Survey ,Comparative ,effectiveness research ,Intracranial pressure ,Response rate (survey) ,Medicine (all) ,Head injury ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,11 Medical And Health Sciences ,Orvostudományok ,3. Good health ,Europe ,Neurosurgery ,medicine.medical_specialty ,Critical Care ,Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0] ,PRESSURE ,Klinikai orvostudományok ,Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] ,03 medical and health sciences ,ICP ,ICU ,medicine ,MANAGEMENT ,Humans ,Monitoring, Physiologic ,business.industry ,MORTALITY ,Research ,3112 Neurosciences ,HEAD-INJURY ,030208 emergency & critical care medicine ,lcsh:RC86-88.9 ,CARE ,medicine.disease ,Emergency & Critical Care Medicine ,nervous system diseases ,traumatic brain injury ,comparative effectiveness research ,survey ,Emergency medicine ,Physical therapy ,Dentistry (all) ,MODERATE ,Human medicine ,business ,030217 neurology & neurosurgery ,EUROPEAN-BRAIN - Abstract
Background No definitive evidence exists on how intracranial hypertension should be treated in patients with traumatic brain injury (TBI). It is therefore likely that centers and practitioners individually balance potential benefits and risks of different intracranial pressure (ICP) management strategies, resulting in practice variation. The aim of this study was to examine variation in monitoring and treatment policies for intracranial hypertension in patients with TBI. Methods A 29-item survey on ICP monitoring and treatment was developed on the basis of literature and expert opinion, and it was pilot-tested in 16 centers. The questionnaire was sent to 68 neurotrauma centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Results The survey was completed by 66 centers (97% response rate). Centers were mainly academic hospitals (n = 60, 91%) and designated level I trauma centers (n = 44, 67%). The Brain Trauma Foundation guidelines were used in 49 (74%) centers. Approximately 90% of the participants (n = 58) indicated placing an ICP monitor in patients with severe TBI and computed tomographic abnormalities. There was no consensus on other indications or on peri-insertion precautions. We found wide variation in the use of first- and second-tier treatments for elevated ICP. Approximately half of the centers were classified as using a relatively aggressive approach to ICP monitoring and treatment (n = 32, 48%), whereas the others were considered more conservative (n = 34, 52%). Conclusions Substantial variation was found regarding monitoring and treatment policies in patients with TBI and intracranial hypertension. The results of this survey indicate a lack of consensus between European neurotrauma centers and provide an opportunity and necessity for comparative effectiveness research. Electronic supplementary material The online version of this article (doi:10.1186/s13054-017-1816-9) contains supplementary material, which is available to authorized users.
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- 2017
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6. Development of a quality indicator set to measure and improve quality of ICU care for patients with traumatic brain injury
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Huijben, Jilske A., Wiegers, Eveline J. A., Polinder, Suzanne, Steyerberg, Ewout W., van der Jagt, Mathieu, Lingsma, Hester F., Delphi panel, Aries, Marcel, Badenes, Rafael, Beishuizen, Albertus, Bilotta, Federico, Chieregato, Arturo, de Keizer, Nicolette F., Cingolani, Emiliano, Citerio, Giuseppe, Cnossen, Maryse, Coburn, Mark, Coles, Jonathan P., Delargy, Mark, Depreitere, Bart, Ercole, Ari, Flaatten, Hans, Golyk, Volodymyr, Maas, Andrew I. R., Grauwmeijer, Erik, Haitsma, Iain, Helbok, Raimund, Hoedemaekers, Cornelia, Jacobs, Bram, Jellema, Korné, Koskinen, Lars-Owe D., Maegele, Marc, Delgado, Maria Cruz Martin, Menon, David, Møller, Kirsten, Moreno, Rui, Nelson, David, Oldenbeuving, Annemarie W., Payen, Jean-Francois, Pejakovic, Jasmina, Ribbbers, Gerard M., Rossaint, Rolf, Schoonman, Guus Geurt, Steiner, Luzius A., Stocchetti, Nino, Taccone, Fabio Silvio, Takala, Riikka, Tenovuo, Olli, Valeinis, Eglis, van den Bergh, Walter M., van Essen, Thomas, van Leeuwen, Nikki, Verhofstad, Michael H. J., Vos, Pieter E., Wilson, Lindsay, Lecky, Fiona, Cnossen, Maryse C., Delphi Panel, Critical care, Anesthesiology, Peri-operative and Emergency medicine (CAPE), Intensive Care, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, MUMC+: MA Medische Staf IC (9), Citerio, Giuseppe [0000-0002-5374-3161], Apollo - University of Cambridge Repository, Huijben, J, Wiegers, E, de Keizer, N, Maas, A, Menon, D, Ercole, A, Citerio, G, Lecky, F, Wilson, L, Cnossen, M, Polinder, S, Steyerberg, E, van der Jagt, M, Lingsma, H, Medical Informatics, APH - Methodology, APH - Quality of Care, APH - Digital Health, Public Health, Rehabilitation Medicine, Neurosurgery, and Surgery
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Quality management ,NEUROTRAUMA EFFECTIVENESS RESEARCH ,Delphi Technique ,Quality indicator ,Delphi method ,CHILDREN ,Quality indicators ,Critical Care and Intensive Care Medicine ,GUIDELINES ,law.invention ,0302 clinical medicine ,Traumatic brain injury ,law ,Surveys and Questionnaires ,Brain Injuries, Traumatic ,Medicine ,Registries ,media_common ,computer.programming_language ,OUTCOMES ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,Trauma registry ,Benchmarking ,Intensive care unit ,Quality Improvement ,3. Good health ,Europe ,Intensive Care Units ,HOSPITAL-CARE ,OF-CARE ,Medical emergency ,Life Sciences & Biomedicine ,Anestesi och intensivvård ,media_common.quotation_subject ,Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0] ,Likert scale ,03 medical and health sciences ,ADHERENCE ,Critical Care Medicine ,Intensive care ,General & Internal Medicine ,Quality indicators, Benchmarking, Traumatic brain injury, Intensive care unit, Trauma registry, Quality of care ,MANAGEMENT ,Humans ,Quality (business) ,VALIDITY ,Expert Testimony ,Quality Indicators, Health Care ,Quality of Health Care ,Quality care ,Science & Technology ,Anesthesiology and Intensive Care ,business.industry ,Research ,Quality of care ,030208 emergency & critical care medicine ,lcsh:RC86-88.9 ,medicine.disease ,Human medicine ,business ,computer ,Delphi - Abstract
Background We aimed to develop a set of quality indicators for patients with traumatic brain injury (TBI) in intensive care units (ICUs) across Europe and to explore barriers and facilitators for implementation of these quality indicators. Methods A preliminary list of 66 quality indicators was developed, based on current guidelines, existing practice variation, and clinical expertise in TBI management at the ICU. Eight TBI experts of the Advisory Committee preselected the quality indicators during a first Delphi round. A larger Europe-wide expert panel was recruited for the next two Delphi rounds. Quality indicator definitions were evaluated on four criteria: validity (better performance on the indicator reflects better processes of care and leads to better patient outcome), feasibility (data are available or easy to obtain), discriminability (variability in clinical practice), and actionability (professionals can act based on the indicator). Experts scored indicators on a 5-point Likert scale delivered by an electronic survey tool. Results The expert panel consisted of 50 experts from 18 countries across Europe, mostly intensivists (N = 24, 48%) and neurosurgeons (N = 7, 14%). Experts agreed on a final set of 42 indicators to assess quality of ICU care: 17 structure indicators, 16 process indicators, and 9 outcome indicators. Experts are motivated to implement this finally proposed set (N = 49, 98%) and indicated routine measurement in registries (N = 41, 82%), benchmarking (N = 42, 84%), and quality improvement programs (N = 41, 82%) as future steps. Administrative burden was indicated as the most important barrier for implementation of the indicator set (N = 48, 98%). Conclusions This Delphi consensus study gives insight in which quality indicators have the potential to improve quality of TBI care at European ICUs. The proposed quality indicator set is recommended to be used across Europe for registry purposes to gain insight in current ICU practices and outcomes of patients with TBI. This indicator set may become an important tool to support benchmarking and quality improvement programs for patients with TBI in the future. Electronic supplementary material The online version of this article (10.1186/s13054-019-2377-x) contains supplementary material, which is available to authorized users.
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- 2019
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7. Variation in Blood Transfusion and Coagulation Management in Traumatic Brain Injury at the Intensive Care Unit: A Survey in 66 Neurotrauma Centers Participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Study
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Huijben, Jilske A., van der Jagt, Mathieu, Cnossen, Maryse C., Kruip, Marieke J.H.A., Haitsma, Iain K., Stocchetti, Nino, Maas, Andrew I.R., Menon, David K., Ercole, Ari, Maegele, Marc, Stanworth, Simon J., Citerio, Giuseppe, Polinder, Suzanne, Steyerberg, Ewout W., Lingsma, Hester F., and on behalf of the CENTER-TBI Investigators and Participants
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BLOOD transfusion , *BLOOD coagulation , *BRAIN injury treatment , *PAIN management , *INTENSIVE care patients , *PHYSIOLOGY - Abstract
Our aim was to describe current approaches and to quantify variability between European intensive care units (ICUs) in patients with traumatic brain injury (TBI). Therefore, we conducted a provider profiling survey as part of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. The ICU Questionnaire was sent to 68 centers from 20 countries across Europe and Israel. For this study, we used ICU questions focused on 1) hemoglobin target level (Hb-TL), 2) coagulation management, and 3) deep venous thromboembolism (DVT) prophylaxis. Seventy-eight participants, mostly intensivists and neurosurgeons of 66 centers, completed the ICU questionnaire. For ICU-patients, half of the centers ( N = 34; 52%) had a defined Hb-TL in their protocol. For patients with TBI, 26 centers (41%) indicated an Hb-TL between 70 and 90 g/L and 38 centers (59%) above 90 g/L. To treat trauma-related hemostatic abnormalities, the use of fresh frozen plasma ( N = 48; 73%) or platelets ( N = 34; 52%) was most often reported, followed by the supplementation of vitamin K ( N = 26; 39%). Most centers reported using DVT prophylaxis with anticoagulants frequently or always ( N = 62; 94%). In the absence of hemorrhagic brain lesions, 14 centers (21%) delayed DVT prophylaxis until 72 h after trauma. If hemorrhagic brain lesions were present, the number of centers delaying DVT prophylaxis for 72 h increased to 29 (46%). Overall, a lack of consensus exists between European ICUs on blood transfusion and coagulation management. The results provide a baseline for the CENTER-TBI study, and the large between-center variation indicates multiple opportunities for comparative effectiveness research. [ABSTRACT FROM AUTHOR]
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- 2018
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8. Variation in general supportive and preventive intensive care management of traumatic brain injury: a survey in 66 neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study
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Huijben, Jilske A, Volovici, Victor, Cnossen, Maryse C, Haitsma, Iain K, Stocchetti, Nino, Maas, Andrew IR, Menon, David K, Ercole, Ari, Citerio, Giuseppe, Nelson, David, Polinder, Suzanne, Steyerberg, Ewout W, Lingsma, Hester F, Van Der Jagt, Mathieu, and CENTER-TBI Investigators And Participants
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Adult ,Male ,Comparative Effectiveness Research ,Fever ,Seizure ,Ventilation ,3. Good health ,Europe ,Intensive Care Units ,Glucose ,Traumatic brain injury ,Trauma Centers ,Surveys and Questionnaires ,Brain Injuries, Traumatic ,Blood pressure ,Humans ,Intensive care unit ,Female ,Survey ,Nutrition ,Program Evaluation ,Quality of Health Care - Abstract
BACKGROUND: General supportive and preventive measures in the intensive care management of traumatic brain injury (TBI) aim to prevent or limit secondary brain injury and optimize recovery. The aim of this survey was to assess and quantify variation in perceptions on intensive care unit (ICU) management of patients with TBI in European neurotrauma centers. METHODS: We performed a survey as part of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. We analyzed 23 questions focused on: 1) circulatory and respiratory management; 2) fever control; 3) use of corticosteroids; 4) nutrition and glucose management; and 5) seizure prophylaxis and treatment. RESULTS: The survey was completed predominantly by intensivists (n = 33, 50%) and neurosurgeons (n = 23, 35%) from 66 centers (97% response rate). The most common cerebral perfusion pressure (CPP) target was > 60 mmHg (n = 39, 60%) and/or an individualized target (n = 25, 38%). To support CPP, crystalloid fluid loading (n = 60, 91%) was generally preferred over albumin (n = 15, 23%), and vasopressors (n = 63, 96%) over inotropes (n = 29, 44%). The most commonly reported target of partial pressure of carbon dioxide in arterial blood (PaCO2) was 36-40 mmHg (4.8-5.3 kPa) in case of controlled intracranial pressure (ICP) < 20 mmHg (n = 45, 69%) and PaCO2 target of 30-35 mmHg (4-4.7 kPa) in case of raised ICP (n = 40, 62%). Almost all respondents indicated to generally treat fever (n = 65, 98%) with paracetamol (n = 61, 92%) and/or external cooling (n = 49, 74%). Conventional glucose management (n = 43, 66%) was preferred over tight glycemic control (n = 18, 28%). More than half of the respondents indicated to aim for full caloric replacement within 7 days (n = 43, 66%) using enteral nutrition (n = 60, 92%). Indications for and duration of seizure prophylaxis varied, and levetiracetam was mostly reported as the agent of choice for both seizure prophylaxis (n = 32, 49%) and treatment (n = 40, 61%). CONCLUSIONS: Practice preferences vary substantially regarding general supportive and preventive measures in TBI patients at ICUs of European neurotrauma centers. These results provide an opportunity for future comparative effectiveness research, since a more evidence-based uniformity in good practices in general ICU management could have a major impact on TBI outcome.
9. Development of a quality indicator set to measure and improve quality of ICU care for patients with traumatic brain injury
- Author
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Huijben, Jilske A, Wiegers, Eveline JA, De Keizer, Nicolette F, Maas, Andrew IR, Menon, David, Ercole, Ari, Citerio, Giuseppe, Lecky, Fiona, Wilson, Lindsay, Cnossen, Maryse C, Polinder, Suzanne, Steyerberg, Ewout W, Van Der Jagt, Mathieu, Lingsma, Hester F, and Delphi Panel
- Subjects
Delphi Technique ,Quality of care ,Trauma registry ,Quality indicators ,Quality Improvement ,3. Good health ,Europe ,Benchmarking ,Intensive Care Units ,Traumatic brain injury ,Surveys and Questionnaires ,Brain Injuries, Traumatic ,Humans ,Intensive care unit ,Registries ,Expert Testimony ,Quality Indicators, Health Care ,Quality of Health Care - Abstract
BACKGROUND: We aimed to develop a set of quality indicators for patients with traumatic brain injury (TBI) in intensive care units (ICUs) across Europe and to explore barriers and facilitators for implementation of these quality indicators. METHODS: A preliminary list of 66 quality indicators was developed, based on current guidelines, existing practice variation, and clinical expertise in TBI management at the ICU. Eight TBI experts of the Advisory Committee preselected the quality indicators during a first Delphi round. A larger Europe-wide expert panel was recruited for the next two Delphi rounds. Quality indicator definitions were evaluated on four criteria: validity (better performance on the indicator reflects better processes of care and leads to better patient outcome), feasibility (data are available or easy to obtain), discriminability (variability in clinical practice), and actionability (professionals can act based on the indicator). Experts scored indicators on a 5-point Likert scale delivered by an electronic survey tool. RESULTS: The expert panel consisted of 50 experts from 18 countries across Europe, mostly intensivists (N = 24, 48%) and neurosurgeons (N = 7, 14%). Experts agreed on a final set of 42 indicators to assess quality of ICU care: 17 structure indicators, 16 process indicators, and 9 outcome indicators. Experts are motivated to implement this finally proposed set (N = 49, 98%) and indicated routine measurement in registries (N = 41, 82%), benchmarking (N = 42, 84%), and quality improvement programs (N = 41, 82%) as future steps. Administrative burden was indicated as the most important barrier for implementation of the indicator set (N = 48, 98%). CONCLUSIONS: This Delphi consensus study gives insight in which quality indicators have the potential to improve quality of TBI care at European ICUs. The proposed quality indicator set is recommended to be used across Europe for registry purposes to gain insight in current ICU practices and outcomes of patients with TBI. This indicator set may become an important tool to support benchmarking and quality improvement programs for patients with TBI in the future.
10. Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe: a CENTER-TBI analysis
- Author
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Huijben, Jilske A, Wiegers, Eveline JA, Lingsma, Hester F, Citerio, Giuseppe, Maas, Andrew IR, 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, and CENTER-TBI Investigators And Participants
- Subjects
Europe ,Intensive Care Units ,Traumatic brain injury ,Critical Care ,Intracranial pressure ,Brain Injuries, Traumatic ,Humans ,Intensive care unit ,Glasgow Coma Scale ,Israel ,Middle Aged ,3. Good health ,Outcome - 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.
11. Comparison of Care System and Treatment Approaches for Patients with Traumatic Brain Injury in China versus Europe: A CENTER-TBI Survey Study
- Author
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Marek Majdan, R.H.M.A. Bartels, Thomas Van Essen, Daniel Kondziella, Juan Sahuquillo, Oliver Sakowitz, Steven Laureys, Angelos Kolias, Ana M Castaño-Leon, Matti Pirinen, Thijs Vande Vyvere, Giuseppe Citerio, Rahul Raj, Jussi Posti, Renán Sánchez-Porras, Andreea Rădoi, Peter Hutchinson, D. James Cooper, Sandra Rossi, Pedro Gomez, Virginia Newcombe, William Stewart, Jonathan Coles, Frederick Zeiler, Aarno Palotie, Paul Dark, Arminas Ragauskas, Intensive Care, Public Health, Feng, J, van Veen, E, Yang, C, Huijben, J, Lingsma, H, Gao, G, Jiang, J, Maas, A, Citerio, G, Molecular Neuroscience and Ageing Research (MOLAR), Psychology 3, Section Neuropsychology, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, RS: FPN NPPP I, Psychiatrie & Neuropsychologie, Collaborative European Neuro Trauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Investigators and Participants, Feng, Junfeng, van Veen, Ernest, Yang, Chun, Huijben, Jilske A, Lingsma, Hester F, Gao, Guoyi, Jiang, Jiyao, Maas, Andrew I R (Collaborative European Neuro Trauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) Investigators and Participants), and Beretta, L
- Subjects
China ,Emergency Medical Services ,030506 rehabilitation ,medicine.medical_specialty ,NEUROTRAUMA EFFECTIVENESS RESEARCH ,Neurologi ,Traumatic brain injury ,Concordance ,medicine.medical_treatment ,Best practice ,Comparative effectiveness research ,Provider profiling ,TBI care ,03 medical and health sciences ,0302 clinical medicine ,Trauma Centers ,Surveys and Questionnaires ,Brain Injuries, Traumatic ,medicine ,MANAGEMENT ,Humans ,CRITERIA ,COMPUTED-TOMOGRAPHY ,CLINICAL DECISION INSTRUMENTS ,business.industry ,Public health ,traumatic brain injury ,comparison, provider profiling, TBI care, traumatic brain injury, variation ,provider profiling ,ADULTS ,medicine.disease ,3. Good health ,Europe ,Intensive Care Units ,Treatment Outcome ,Neurology ,CT HEAD RULE ,comparison ,Family medicine ,Decompressive craniectomy ,Human medicine ,Neurology (clinical) ,variation ,0305 other medical science ,business ,Craniotomy ,030217 neurology & neurosurgery - Abstract
Traumatic brain injury (TBI) poses a huge public health and societal problem worldwide. Uncertainty exists on how care system and treatment approaches for TBI worked in China may differ from those in Europe. Better knowledge on this is important to facilitate interpretation of findings reported by Chinese researchers and to inform opportunities for collaborative studies. We aimed to investigate concordance and variations in TBI care between Chinese and European neurotrauma centers. Investigators from 52 centers in China and 68 in Europe involved in the Collaborative European Neuro Trauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study were invited to complete provider profiling (PP) questionnaires, which covered the main aspects of care system and treatment approaches of TBI care. Participating Chinese and European centers were mainly publicly funded and academic. More centers in China indicated available dedicated neuro-intensive care than those in Europe (98% vs. 60%), and treatment decisions in the ICU were mainly determined by neurosurgeons (58%) in China while in Europe, (neuro)intensivists often took the lead (61%). The ambulance dispatching system was automatic in half of Chinese centers (49%), whereas selective dispatching was more common in European centers (74%). For treatment of refractory intracranial hypertension, a decompressive craniectomy was more frequently regarded as general policy in China compared with in Europe (89% vs. 45%). We observed both concordance and substantial variations with regard to the various aspects of TBI care between Chinese and European centers. These findings are fundamental to guide future research and offer opportunities for collaborative comparative effectiveness research to identify best practices., Funding Agencies:National Natural Science Foundation of China (NSFC)Hannelore Kohl Stiftung (Germany) OneMind (USA) Integra LifeSciences Corporation (USA)
- Published
- 2020
12. Variation in general supportive and preventive intensive care management of traumatic brain injury: a survey in 66 neurotrauma centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study
- Author
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R.H.M.A. Bartels, Paul M. Parizel, Thomas Van Essen, Daniel Kondziella, Juan Sahuquillo, Oliver Sakowitz, Rafael Badenes, Marek Czosnyka, Mathieu Van der Jagt, Steven Laureys, Angelos Kolias, Ana M Castaño-Leon, Ari Ercole, Thijs Vande Vyvere, Morten Blaabjerg, David Nelson, Giuseppe Citerio, Victor Volovici, Rahul Raj, Linda Lanyon, Pim Pullens, Edgar Santos, Renán Sánchez-Porras, Peter Hutchinson, Sandra Rossi, Pedro Gomez, Virginia Newcombe, William Stewart, Jonathan Coles, Monika Bullinger, Diederik Dippel, Helen Dawes, Jilske (Antonia) Huijben, Alfonso Lagares, Arminas Ragauskas, Barbara Sahakian, Emmanuel Andreas Stamatakis, Ragauskas, Arminas, Ročka, Saulius, Vilcinis, Rimantas, Molecular Neuroscience and Ageing Research (MOLAR), CTR-TBI Investigators Participants, Neurokirurgian yksikkö, Clinicum, Huijben, Jilske A, Volovici, Victor, Cnossen, Maryse C, Haitsma, Iain K, Stocchetti, Nino, Maas, Andrew IR, Menon, David K, Ercole, Ari, Citerio, Giuseppe, Nelson, David, Polinder, Suzanne, Steyerberg, Ewout W, Lingsma, Hester F, Van der Jagt, Mathieu (CENTER-TBI investigators and participants), Beretta, Luigi, Rocka, Saulius, „Springer' grupė, Public Health, Neurosurgery, Intensive Care, Menon, David [0000-0002-3228-9692], Ercole, Ari [0000-0001-8350-8093], Apollo - University of Cambridge Repository, Section Neuropsychology, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, RS: FPN NPPP I, Psychiatrie & Neuropsychologie, Huijben, J, Volovici, V, Cnossen, M, Haitsma, I, Stocchetti, N, Maas, A, Menon, D, Ercole, A, Citerio, G, Nelson, D, Polinder, S, Steyerberg, E, Lingsma, H, and van der Jagt, M
- Subjects
Male ,Comparative Effectiveness Research ,Placebo-controlled study ,use of corticosteroid ,Critical Care and Intensive Care Medicine ,PLACEBO-CONTROLLED TRIAL ,GUIDELINES ,VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Nevrologi: 752 ,3124 Neurology and psychiatry ,law.invention ,survey, Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury, CENTER-TBI, circulatory and respiratory management ,0302 clinical medicine ,Traumatic brain injury ,seizure prophylaxis and treatment ,Trauma Centers ,law ,Surveys and Questionnaires ,Brain Injuries, Traumatic ,Medicine and Health Sciences ,Surveys and Questionnaire ,intensive care unit ,traumatic brain injury ,glucose ,nutrition ,fever ,ventilation ,blood pressure ,seizure ,survey ,Europe ,fever control ,Survey ,Intracranial pressure ,OUTCOMES ,Trauma Center ,Brain Injuries, Traumatic/therapy ,RESUSCITATION ,nutrition and glucose management ,Head injury ,lcsh:Medical emergencies. Critical care. Intensive care. First aid ,INTRACRANIAL HYPERTENSION ,Intensive care unit ,Seizure ,3. Good health ,Intensive Care Units ,Blood pressure ,Female ,CRITICALLY-ILL PATIENTS ,Human ,Adult ,medicine.medical_specialty ,Fever ,Comparative effectiveness research ,Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0] ,IMPROVEMENT ,ALBUMIN ,Glucose ,Nutrition ,Ventilation ,Quality of Health Care/standards ,03 medical and health sciences ,medicine ,Humans ,Cerebral perfusion pressure ,Quality of Health Care ,MRC CRASH ,Intensive Care Units/organization & administration ,business.industry ,Research ,HEAD-INJURY ,030208 emergency & critical care medicine ,lcsh:RC86-88.9 ,medicine.disease ,3126 Surgery, anesthesiology, intensive care, radiology ,Trauma Centers/organization & administration ,Program Evaluation/statistics & numerical data ,Emergency medicine ,VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Neurology: 752 ,MODERATE ,Human medicine ,business ,030217 neurology & neurosurgery ,Program Evaluation - Abstract
Background General supportive and preventive measures in the intensive care management of traumatic brain injury (TBI) aim to prevent or limit secondary brain injury and optimize recovery. The aim of this survey was to assess and quantify variation in perceptions on intensive care unit (ICU) management of patients with TBI in European neurotrauma centers. Methods We performed a survey as part of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. We analyzed 23 questions focused on: 1) circulatory and respiratory management; 2) fever control; 3) use of corticosteroids; 4) nutrition and glucose management; and 5) seizure prophylaxis and treatment. Results The survey was completed predominantly by intensivists (n = 33, 50%) and neurosurgeons (n = 23, 35%) from 66 centers (97% response rate). The most common cerebral perfusion pressure (CPP) target was > 60 mmHg (n = 39, 60%) and/or an individualized target (n = 25, 38%). To support CPP, crystalloid fluid loading (n = 60, 91%) was generally preferred over albumin (n = 15, 23%), and vasopressors (n = 63, 96%) over inotropes (n = 29, 44%). The most commonly reported target of partial pressure of carbon dioxide in arterial blood (PaCO2) was 36–40 mmHg (4.8–5.3 kPa) in case of controlled intracranial pressure (ICP)
- Published
- 2018
- Full Text
- View/download PDF
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