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1. Rehabilitation and outcomes after complicated vs uncomplicated mild TBI: results from the CENTER-TBI study

Author

Howe, E, Zeldovich, M, Andelic, N, von Steinbuechel, N, Fure, S, Borgen, I, Forslund, M, Hellstrom, T, Soberg, H, Sveen, U, Rasmussen, M, Kleffelgaard, I, Tverdal, C, Helseth, E, Lovstad, M, Lu, J, Arango-Lasprilla, J, Tenovuo, O, Azouvi, P, Dawes, H, Roe, C, Akerlund, C, Amrein, K, Andreassen, L, Anke, A, Antoni, A, Audibert, G, Azzolini, M, Bartels, R, Barzo, P, Beauvais, R, Beer, R, Bellander, B, Belli, A, Benali, H, Berardino, M, Beretta, L, Blaabjerg, M, Bragge, P, Brazinova, A, Brinck, V, Brooker, J, Brorsson, C, Buki, A, Bullinger, M, Cabeleira, M, Caccioppola, A, Calappi, E, Calvi, M, Cameron, P, Carbayo Lozano, G, Carbonara, M, Cavallo, S, Chevallard, G, Chieregato, A, Citerio, G, Clusmann, H, Coburn, M, Coles, J, Cooper, J, Correia, M, Covic, A, Curry, N, Czeiter, E, Czosnyka, M, Dahyot-Fizelier, C, Dark, P, De Keyser, V, Degos, V, Dellacorte, F, Denboogert, H, Depreitere, B, Dilvesi, D, Dixit, A, Donoghue, E, Dreier, J, Duliere, G, Ercole, A, Esser, P, Ezer, E, Fabricius, M, Feigin, V, Foks, K, Frisvold, S, Furmanov, A, Gagliardo, P, Galanaud, D, Gantner, D, Gao, G, George, P, Ghuysen, A, Giga, L, Glocker, B, Golubovic, J, Gomez, P, Gratz, J, Gravesteijn, B, Grossi, F, Gruen, R, Gupta, D, Haagsma, J, Haitsma, I, Helbok, R, Horton, L, Huijben, J, Hutchinson, P, Jacobs, B, Jankowski, S, Jarrett, M, Jiang, J, Johnson, F, Jones, K, Karan, M, Kolias, A, Kompanje, E, Kondziella, D, Kornaropoulos, E, Koskinen, L, Kovacs, N, Kowark, A, Lagares, A, Lanyon, L, Laureys, S, Lecky, F, Ledoux, D, Lefering, R, Legrand, V, Lejeune, A, Levi, L, Lightfoot, R, Lingsma, H, Maas, A, Castano-Leon, A, Maegele, M, Majdan, M, Manara, A, Manley, G, Martino, C, Marechal, H, Mattern, J, Mcmahon, C, Melegh, B, Menon, D, Menovsky, T, Mikolic, A, Misset, B, Muraleedharan, V, Murray, L, Negru, A, Nelson, D, Newcombe, V, Nieboer, D, Nyiradi, J, Olubukola, O, Oresic, M, Ortolano, F, Palotie, A, Parizel, P, Payen, J, Perera, N, Perlbarg, V, Persona, P, Peul, W, Piippo-Karjalainen, A, Pirinen, M, Pisica, D, Ples, H, Polinder, S, Pomposo, I, Posti, J, Puybasset, L, Radoi, A, Ragauskas, A, Raj, R, Rambadagalla, M, Helmrich, I, Rhodes, J, Richardson, S, Richter, S, Ripatti, S, Rocka, S, Roise, O, Rosand, J, Rosenfeld, J, Rosenlund, C, Rosenthal, G, Rossaint, R, Rossi, S, Rueckert, D, Rusnak, M, Sahuquillo, J, Sakowitz, O, Sanchez-Porras, R, Sandor, J, Schafer, N, Schmidt, S, Schoechl, H, Schoonman, G, Schou, R, Schwendenwein, E, Sewalt, C, Singh, R, Skandsen, T, Smielewski, P, Sorinola, A, Stamatakis, E, Stanworth, S, Stevens, R, Stewart, W, Steyerberg, E, Stocchetti, N, Sundstrom, N, Takala, R, Tamas, V, Tamosuitis, T, Taylor, M, Ao, B, Theadom, A, Thomas, M, Tibboel, D, Timmers, M, Tolias, C, Trapani, T, Tudora, C, Unterberg, A, Vajkoczy, P, Vallance, S, Valeinis, E, Vamos, Z, van der Jagt, M, Van der Steen, G, van der Naalt, J, van Dijck, J, van Erp, I, van Essen, T, Van Hecke, W, van Heugten, C, Van Praag, D, van Veen, E, Vyvere, T, van Wijk, R, Vargiolu, A, Vega, E, Velt, K, Verheyden, J, Vespa, P, Vik, A, Vilcinis, R, Volovici, V, von Steinbuchel, N, Voormolen, D, Vulekovic, P, Wang, K, Whitehouse, D, Wiegers, E, Williams, G, Wilson, L, Winzeck, S, Wolf, S, Yang, Z, Ylen, P, Younsi, A, Zeiler, F, Zelinkova, V, Ziverte, A, Zoerle, T, Howe E. I., Zeldovich M., Andelic N., von Steinbuechel N., Fure S. C. R., Borgen I. M. H., Forslund M. V., Hellstrom T., Soberg H. L., Sveen U., Rasmussen M., Kleffelgaard I., Tverdal C., Helseth E., Lovstad M., Lu J., Arango-Lasprilla J. C., Tenovuo O., Azouvi P., Dawes H., Roe C., Akerlund C., Amrein K., Andreassen L., Anke A., Antoni A., Audibert G., Azzolini M. L., Bartels R., Barzo P., Beauvais R., Beer R., Bellander B. -M., Belli A., Benali H., Berardino M., Beretta L., Blaabjerg M., Bragge P., Brazinova A., Brinck V., Brooker J., Brorsson C., Buki A., Bullinger M., Cabeleira M., Caccioppola A., Calappi E., Calvi M. R., Cameron P., Carbayo Lozano G., Carbonara M., Cavallo S., Chevallard G., Chieregato A., Citerio G., Clusmann H., Coburn M., Coles J., Cooper J. D., Correia M., Covic A., Curry N., Czeiter E., Czosnyka M., Dahyot-Fizelier C., Dark P., De Keyser V., Degos V., DellaCorte F., denBoogert H., Depreitere B., Dilvesi D., Dixit A., Donoghue E., Dreier J., Duliere G. -L., Ercole A., Esser P., Ezer E., Fabricius M., Feigin V. L., Foks K., Frisvold S., Furmanov A., Gagliardo P., Galanaud D., Gantner D., Gao G., George P., Ghuysen A., Giga L., Glocker B., Golubovic J., Gomez P. A., Gratz J., Gravesteijn B., Grossi F., Gruen R. L., Gupta D., Haagsma J. A., Haitsma I., Helbok R., Horton L., Huijben J., Hutchinson P. J., Jacobs B., Jankowski S., Jarrett M., Jiang J. -Y., Johnson F., Jones K., Karan M., Kolias A. G., Kompanje E., Kondziella D., Kornaropoulos E., Koskinen L. -O., Kovacs N., Kowark A., Lagares A., Lanyon L., Laureys S., Lecky F., Ledoux D., Lefering R., Legrand V., Lejeune A., Levi L., Lightfoot R., Lingsma H., Maas A. I. R., Castano-Leon A. M., Maegele M., Majdan M., Manara A., Manley G., Martino C., Marechal H., Mattern J., McMahon C., Melegh B., Menon D., Menovsky T., Mikolic A., Misset B., Muraleedharan V., Murray L., Negru A., Nelson D., Newcombe V., Nieboer D., Nyiradi J., Olubukola O., Oresic M., Ortolano F., Palotie A., Parizel P. M., Payen J. -F., Perera N., Perlbarg V., Persona P., Peul W., Piippo-Karjalainen A., Pirinen M., Pisica D., Ples H., Polinder S., Pomposo I., Posti J. P., Puybasset L., Radoi A., Ragauskas A., Raj R., Rambadagalla M., Helmrich I. R., Rhodes J., Richardson S., Richter S., Ripatti S., Rocka S., Roise O., Rosand J., Rosenfeld J. V., Rosenlund C., Rosenthal G., Rossaint R., Rossi S., Rueckert D., Rusnak M., Sahuquillo J., Sakowitz O., Sanchez-Porras R., Sandor J., Schafer N., Schmidt S., Schoechl H., Schoonman G., Schou R. F., Schwendenwein E., Sewalt C., Singh R. D., Skandsen T., Smielewski P., Sorinola A., Stamatakis E., Stanworth S., Stevens R., Stewart W., Steyerberg E. W., Stocchetti N., Sundstrom N., Takala R., Tamas V., Tamosuitis T., Taylor M. S., Ao B. T., Theadom A., Thomas M., Tibboel D., Timmers M., Tolias C., Trapani T., Tudora C. M., Unterberg A., Vajkoczy P., Vallance S., Valeinis E., Vamos Z., van der Jagt M., Van der Steen G., van der Naalt J., van Dijck J. T. J. M., van Erp I. A. M., van Essen T. A., Van Hecke W., van Heugten C., Van Praag D., van Veen E., Vyvere T. V., van Wijk R. P. J., Vargiolu A., Vega E., Velt K., Verheyden J., Vespa P. M., Vik A., Vilcinis R., Volovici V., von Steinbuchel N., Voormolen D., Vulekovic P., Wang K. K. W., Whitehouse D., Wiegers E., Williams G., Wilson L., Winzeck S., Wolf S., Yang Z., Ylen P., Younsi A., Zeiler F. A., Zelinkova V., Ziverte A., Zoerle T., Howe, E, Zeldovich, M, Andelic, N, von Steinbuechel, N, Fure, S, Borgen, I, Forslund, M, Hellstrom, T, Soberg, H, Sveen, U, Rasmussen, M, Kleffelgaard, I, Tverdal, C, Helseth, E, Lovstad, M, Lu, J, Arango-Lasprilla, J, Tenovuo, O, Azouvi, P, Dawes, H, Roe, C, Akerlund, C, Amrein, K, Andreassen, L, Anke, A, Antoni, A, Audibert, G, Azzolini, M, Bartels, R, Barzo, P, Beauvais, R, Beer, R, Bellander, B, Belli, A, Benali, H, Berardino, M, Beretta, L, Blaabjerg, M, Bragge, P, Brazinova, A, Brinck, V, Brooker, J, Brorsson, C, Buki, A, Bullinger, M, Cabeleira, M, Caccioppola, A, Calappi, E, Calvi, M, Cameron, P, Carbayo Lozano, G, Carbonara, M, Cavallo, S, Chevallard, G, Chieregato, A, Citerio, G, Clusmann, H, Coburn, M, Coles, J, Cooper, J, Correia, M, Covic, A, Curry, N, Czeiter, E, Czosnyka, M, Dahyot-Fizelier, C, Dark, P, De Keyser, V, Degos, V, Dellacorte, F, Denboogert, H, Depreitere, B, Dilvesi, D, Dixit, A, Donoghue, E, Dreier, J, Duliere, G, Ercole, A, Esser, P, Ezer, E, Fabricius, M, Feigin, V, Foks, K, Frisvold, S, Furmanov, A, Gagliardo, P, Galanaud, D, Gantner, D, Gao, G, George, P, Ghuysen, A, Giga, L, Glocker, B, Golubovic, J, Gomez, P, Gratz, J, Gravesteijn, B, Grossi, F, Gruen, R, Gupta, D, Haagsma, J, Haitsma, I, Helbok, R, Horton, L, Huijben, J, Hutchinson, P, Jacobs, B, Jankowski, S, Jarrett, M, Jiang, J, Johnson, F, Jones, K, Karan, M, Kolias, A, Kompanje, E, Kondziella, D, Kornaropoulos, E, Koskinen, L, Kovacs, N, Kowark, A, Lagares, A, Lanyon, L, Laureys, S, Lecky, F, Ledoux, D, Lefering, R, Legrand, V, Lejeune, A, Levi, L, Lightfoot, R, Lingsma, H, Maas, A, Castano-Leon, A, Maegele, M, Majdan, M, Manara, A, Manley, G, Martino, C, Marechal, H, Mattern, J, Mcmahon, C, Melegh, B, Menon, D, Menovsky, T, Mikolic, A, Misset, B, Muraleedharan, V, Murray, L, Negru, A, Nelson, D, Newcombe, V, Nieboer, D, Nyiradi, J, Olubukola, O, Oresic, M, Ortolano, F, Palotie, A, Parizel, P, Payen, J, Perera, N, Perlbarg, V, Persona, P, Peul, W, Piippo-Karjalainen, A, Pirinen, M, Pisica, D, Ples, H, Polinder, S, Pomposo, I, Posti, J, Puybasset, L, Radoi, A, Ragauskas, A, Raj, R, Rambadagalla, M, Helmrich, I, Rhodes, J, Richardson, S, Richter, S, Ripatti, S, Rocka, S, Roise, O, Rosand, J, Rosenfeld, J, Rosenlund, C, Rosenthal, G, Rossaint, R, Rossi, S, Rueckert, D, Rusnak, M, Sahuquillo, J, Sakowitz, O, Sanchez-Porras, R, Sandor, J, Schafer, N, Schmidt, S, Schoechl, H, Schoonman, G, Schou, R, Schwendenwein, E, Sewalt, C, Singh, R, Skandsen, T, Smielewski, P, Sorinola, A, Stamatakis, E, Stanworth, S, Stevens, R, Stewart, W, Steyerberg, E, Stocchetti, N, Sundstrom, N, Takala, R, Tamas, V, Tamosuitis, T, Taylor, M, Ao, B, Theadom, A, Thomas, M, Tibboel, D, Timmers, M, Tolias, C, Trapani, T, Tudora, C, Unterberg, A, Vajkoczy, P, Vallance, S, Valeinis, E, Vamos, Z, van der Jagt, M, Van der Steen, G, van der Naalt, J, van Dijck, J, van Erp, I, van Essen, T, Van Hecke, W, van Heugten, C, Van Praag, D, van Veen, E, Vyvere, T, van Wijk, R, Vargiolu, A, Vega, E, Velt, K, Verheyden, J, Vespa, P, Vik, A, Vilcinis, R, Volovici, V, von Steinbuchel, N, Voormolen, D, Vulekovic, P, Wang, K, Whitehouse, D, Wiegers, E, Williams, G, Wilson, L, Winzeck, S, Wolf, S, Yang, Z, Ylen, P, Younsi, A, Zeiler, F, Zelinkova, V, Ziverte, A, Zoerle, T, Howe E. I., Zeldovich M., Andelic N., von Steinbuechel N., Fure S. C. R., Borgen I. M. H., Forslund M. V., Hellstrom T., Soberg H. L., Sveen U., Rasmussen M., Kleffelgaard I., Tverdal C., Helseth E., Lovstad M., Lu J., Arango-Lasprilla J. C., Tenovuo O., Azouvi P., Dawes H., Roe C., Akerlund C., Amrein K., Andreassen L., Anke A., Antoni A., Audibert G., Azzolini M. L., Bartels R., Barzo P., Beauvais R., Beer R., Bellander B. -M., Belli A., Benali H., Berardino M., Beretta L., Blaabjerg M., Bragge P., Brazinova A., Brinck V., Brooker J., Brorsson C., Buki A., Bullinger M., Cabeleira M., Caccioppola A., Calappi E., Calvi M. R., Cameron P., Carbayo Lozano G., Carbonara M., Cavallo S., Chevallard G., Chieregato A., Citerio G., Clusmann H., Coburn M., Coles J., Cooper J. D., Correia M., Covic A., Curry N., Czeiter E., Czosnyka M., Dahyot-Fizelier C., Dark P., De Keyser V., Degos V., DellaCorte F., denBoogert H., Depreitere B., Dilvesi D., Dixit A., Donoghue E., Dreier J., Duliere G. -L., Ercole A., Esser P., Ezer E., Fabricius M., Feigin V. L., Foks K., Frisvold S., Furmanov A., Gagliardo P., Galanaud D., Gantner D., Gao G., George P., Ghuysen A., Giga L., Glocker B., Golubovic J., Gomez P. A., Gratz J., Gravesteijn B., Grossi F., Gruen R. L., Gupta D., Haagsma J. A., Haitsma I., Helbok R., Horton L., Huijben J., Hutchinson P. J., Jacobs B., Jankowski S., Jarrett M., Jiang J. -Y., Johnson F., Jones K., Karan M., Kolias A. G., Kompanje E., Kondziella D., Kornaropoulos E., Koskinen L. -O., Kovacs N., Kowark A., Lagares A., Lanyon L., Laureys S., Lecky F., Ledoux D., Lefering R., Legrand V., Lejeune A., Levi L., Lightfoot R., Lingsma H., Maas A. I. R., Castano-Leon A. M., Maegele M., Majdan M., Manara A., Manley G., Martino C., Marechal H., Mattern J., McMahon C., Melegh B., Menon D., Menovsky T., Mikolic A., Misset B., Muraleedharan V., Murray L., Negru A., Nelson D., Newcombe V., Nieboer D., Nyiradi J., Olubukola O., Oresic M., Ortolano F., Palotie A., Parizel P. M., Payen J. -F., Perera N., Perlbarg V., Persona P., Peul W., Piippo-Karjalainen A., Pirinen M., Pisica D., Ples H., Polinder S., Pomposo I., Posti J. P., Puybasset L., Radoi A., Ragauskas A., Raj R., Rambadagalla M., Helmrich I. R., Rhodes J., Richardson S., Richter S., Ripatti S., Rocka S., Roise O., Rosand J., Rosenfeld J. V., Rosenlund C., Rosenthal G., Rossaint R., Rossi S., Rueckert D., Rusnak M., Sahuquillo J., Sakowitz O., Sanchez-Porras R., Sandor J., Schafer N., Schmidt S., Schoechl H., Schoonman G., Schou R. F., Schwendenwein E., Sewalt C., Singh R. D., Skandsen T., Smielewski P., Sorinola A., Stamatakis E., Stanworth S., Stevens R., Stewart W., Steyerberg E. W., Stocchetti N., Sundstrom N., Takala R., Tamas V., Tamosuitis T., Taylor M. S., Ao B. T., Theadom A., Thomas M., Tibboel D., Timmers M., Tolias C., Trapani T., Tudora C. M., Unterberg A., Vajkoczy P., Vallance S., Valeinis E., Vamos Z., van der Jagt M., Van der Steen G., van der Naalt J., van Dijck J. T. J. M., van Erp I. A. M., van Essen T. A., Van Hecke W., van Heugten C., Van Praag D., van Veen E., Vyvere T. V., van Wijk R. P. J., Vargiolu A., Vega E., Velt K., Verheyden J., Vespa P. M., Vik A., Vilcinis R., Volovici V., von Steinbuchel N., Voormolen D., Vulekovic P., Wang K. K. W., Whitehouse D., Wiegers E., Williams G., Wilson L., Winzeck S., Wolf S., Yang Z., Ylen P., Younsi A., Zeiler F. A., Zelinkova V., Ziverte A., and Zoerle T.

Abstract

Background: Despite existing guidelines for managing mild traumatic brain injury (mTBI), evidence-based treatments are still scarce and large-scale studies on the provision and impact of specific rehabilitation services are needed. This study aimed to describe the provision of rehabilitation to patients after complicated and uncomplicated mTBI and investigate factors associated with functional outcome, symptom burden, and TBI-specific health-related quality of life (HRQOL) up to six months after injury. Methods: Patients (n = 1379) with mTBI from the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study who reported whether they received rehabilitation services during the first six months post-injury and who participated in outcome assessments were included. Functional outcome was measured with the Glasgow Outcome Scale – Extended (GOSE), symptom burden with the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and HRQOL with the Quality of Life after Brain Injury – Overall Scale (QOLIBRI-OS). We examined whether transition of care (TOC) pathways, receiving rehabilitation services, sociodemographic (incl. geographic), premorbid, and injury-related factors were associated with outcomes using regression models. For easy comparison, we estimated ordinal regression models for all outcomes where the scores were classified based on quantiles. Results: Overall, 43% of patients with complicated and 20% with uncomplicated mTBI reported receiving rehabilitation services, primarily in physical and cognitive domains. Patients with complicated mTBI had lower functional level, higher symptom burden, and lower HRQOL compared to uncomplicated mTBI. Rehabilitation services at three or six months and a higher number of TOC were associated with unfavorable outcomes in all models, in addition to pre-morbid psychiatric problems. Being male and having more than 13 years of education was associated with more favorable outcomes. Sustaining major trauma w

Published
2022

2. Rehabilitation and outcomes after complicated vs uncomplicated mild TBI: results from the CENTER-TBI study

Author

Howe E. I., Zeldovich M., Andelic N., von Steinbuechel N., Fure S. C. R., Borgen I. M. H., Forslund M. V., Hellstrom T., Soberg H. L., Sveen U., Rasmussen M., Kleffelgaard I., Tverdal C., Helseth E., Lovstad M., Lu J., Arango-Lasprilla J. C., Tenovuo O., Azouvi P., Dawes H., Roe C., Akerlund C., Amrein K., Andreassen L., Anke A., Antoni A., Audibert G., Azzolini M. L., Bartels R., Barzo P., Beauvais R., Beer R., Bellander B. -M., Belli A., Benali H., Berardino M., Beretta L., Blaabjerg M., Bragge P., Brazinova A., Brinck V., Brooker J., Brorsson C., Buki A., Bullinger M., Cabeleira M., Caccioppola A., Calappi E., Calvi M. R., Cameron P., Carbayo Lozano G., Carbonara M., Cavallo S., Chevallard G., Chieregato A., Citerio G., Clusmann H., Coburn M., Coles J., Cooper J. D., Correia M., Covic A., Curry N., Czeiter E., Czosnyka M., Dahyot-Fizelier C., Dark P., De Keyser V., Degos V., DellaCorte F., denBoogert H., Depreitere B., Dilvesi D., Dixit A., Donoghue E., Dreier J., Duliere G. -L., Ercole A., Esser P., Ezer E., Fabricius M., Feigin V. L., Foks K., Frisvold S., Furmanov A., Gagliardo P., Galanaud D., Gantner D., Gao G., George P., Ghuysen A., Giga L., Glocker B., Golubovic J., Gomez P. A., Gratz J., Gravesteijn B., Grossi F., Gruen R. L., Gupta D., Haagsma J. A., Haitsma I., Helbok R., Horton L., Huijben J., Hutchinson P. J., Jacobs B., Jankowski S., Jarrett M., Jiang J. -Y., Johnson F., Jones K., Karan M., Kolias A. G., Kompanje E., Kondziella D., Kornaropoulos E., Koskinen L. -O., Kovacs N., Kowark A., Lagares A., Lanyon L., Laureys S., Lecky F., Ledoux D., Lefering R., Legrand V., Lejeune A., Levi L., Lightfoot R., Lingsma H., Maas A. I. R., Castano-Leon A. M., Maegele M., Majdan M., Manara A., Manley G., Martino C., Marechal H., Mattern J., McMahon C., Melegh B., Menon D., Menovsky T., Mikolic A., Misset B., Muraleedharan V., Murray L., Negru A., Nelson D., Newcombe V., Nieboer D., Nyiradi J., Olubukola O., Oresic M., Ortolano F., Palotie A., Parizel P. M., Payen J. -F., Perera N., Perlbarg V., Persona P., Peul W., Piippo-Karjalainen A., Pirinen M., Pisica D., Ples H., Polinder S., Pomposo I., Posti J. P., Puybasset L., Radoi A., Ragauskas A., Raj R., Rambadagalla M., Helmrich I. R., Rhodes J., Richardson S., Richter S., Ripatti S., Rocka S., Roise O., Rosand J., Rosenfeld J. V., Rosenlund C., Rosenthal G., Rossaint R., Rossi S., Rueckert D., Rusnak M., Sahuquillo J., Sakowitz O., Sanchez-Porras R., Sandor J., Schafer N., Schmidt S., Schoechl H., Schoonman G., Schou R. F., Schwendenwein E., Sewalt C., Singh R. D., Skandsen T., Smielewski P., Sorinola A., Stamatakis E., Stanworth S., Stevens R., Stewart W., Steyerberg E. W., Stocchetti N., Sundstrom N., Takala R., Tamas V., Tamosuitis T., Taylor M. S., Ao B. T., Theadom A., Thomas M., Tibboel D., Timmers M., Tolias C., Trapani T., Tudora C. M., Unterberg A., Vajkoczy P., Vallance S., Valeinis E., Vamos Z., van der Jagt M., Van der Steen G., van der Naalt J., van Dijck J. T. J. M., van Erp I. A. M., van Essen T. A., Van Hecke W., van Heugten C., Van Praag D., van Veen E., Vyvere T. V., van Wijk R. P. J., Vargiolu A., Vega E., Velt K., Verheyden J., Vespa P. M., Vik A., Vilcinis R., Volovici V., von Steinbuchel N., Voormolen D., Vulekovic P., Wang K. K. W., Whitehouse D., Wiegers E., Williams G., Wilson L., Winzeck S., Wolf S., Yang Z., Ylen P., Younsi A., Zeiler F. A., Zelinkova V., Ziverte A., Zoerle T., Apollo - University of Cambridge Repository, Ragauskas, Arminas, Rocka, Saulius, Tamosuitis, Tomas, Vilcinis, Rimantas, „Springer Nature' grupė, Ročka, Saulius, Tamošuitis, Tomas, Molecular Neuroscience and Ageing Research (MOLAR), Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Seventh Framework Programme, FP7, European Commission, EC: 602150, Sigrid Juséliuksen Säätiö, Pécsi Tudományegyetem, PTE, OT has received funding from consultancy for NeuroTraumaSciences Ltd. and from Sigrid Juselius Foundation. The other authors declare no competing interests., CENTER-TBI was supported by the European Union 7th Framework programme (EC grant 602150). Additional funding was obtained from the Hannelore Kohl Stiftung (Germany), from OneMind (USA), and from Integra LifeSciences Corporation (USA). The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report., Hungarian Brain Research Program - Grant No. KTIA_13_NAP-A-II/8, University of Pécs, Pécs, Hungary 88, European Project: 602150,EC:FP7:HEALTH,FP7-HEALTH-2013-INNOVATION-1,CENTER-TBI(2013), Howe, E, Zeldovich, M, Andelic, N, von Steinbuechel, N, Fure, S, Borgen, I, Forslund, M, Hellstrom, T, Soberg, H, Sveen, U, Rasmussen, M, Kleffelgaard, I, Tverdal, C, Helseth, E, Lovstad, M, Lu, J, Arango-Lasprilla, J, Tenovuo, O, Azouvi, P, Dawes, H, Roe, C, Akerlund, C, Amrein, K, Andreassen, L, Anke, A, Antoni, A, Audibert, G, Azzolini, M, Bartels, R, Barzo, P, Beauvais, R, Beer, R, Bellander, B, Belli, A, Benali, H, Berardino, M, Beretta, L, Blaabjerg, M, Bragge, P, Brazinova, A, Brinck, V, Brooker, J, Brorsson, C, Buki, A, Bullinger, M, Cabeleira, M, Caccioppola, A, Calappi, E, Calvi, M, Cameron, P, Carbayo Lozano, G, Carbonara, M, Cavallo, S, Chevallard, G, Chieregato, A, Citerio, G, Clusmann, H, Coburn, M, Coles, J, Cooper, J, Correia, M, Covic, A, Curry, N, Czeiter, E, Czosnyka, M, Dahyot-Fizelier, C, Dark, P, De Keyser, V, Degos, V, Dellacorte, F, Denboogert, H, Depreitere, B, Dilvesi, D, Dixit, A, Donoghue, E, Dreier, J, Duliere, G, Ercole, A, Esser, P, Ezer, E, Fabricius, M, Feigin, V, Foks, K, Frisvold, S, Furmanov, A, Gagliardo, P, Galanaud, D, Gantner, D, Gao, G, George, P, Ghuysen, A, Giga, L, Glocker, B, Golubovic, J, Gomez, P, Gratz, J, Gravesteijn, B, Grossi, F, Gruen, R, Gupta, D, Haagsma, J, Haitsma, I, Helbok, R, Horton, L, Huijben, J, Hutchinson, P, Jacobs, B, Jankowski, S, Jarrett, M, Jiang, J, Johnson, F, Jones, K, Karan, M, Kolias, A, Kompanje, E, Kondziella, D, Kornaropoulos, E, Koskinen, L, Kovacs, N, Kowark, A, Lagares, A, Lanyon, L, Laureys, S, Lecky, F, Ledoux, D, Lefering, R, Legrand, V, Lejeune, A, Levi, L, Lightfoot, R, Lingsma, H, Maas, A, Castano-Leon, A, Maegele, M, Majdan, M, Manara, A, Manley, G, Martino, C, Marechal, H, Mattern, J, Mcmahon, C, Melegh, B, Menon, D, Menovsky, T, Mikolic, A, Misset, B, Muraleedharan, V, Murray, L, Negru, A, Nelson, D, Newcombe, V, Nieboer, D, Nyiradi, J, Olubukola, O, Oresic, M, Ortolano, F, Palotie, A, Parizel, P, Payen, J, Perera, N, Perlbarg, V, Persona, P, Peul, W, Piippo-Karjalainen, A, Pirinen, M, Pisica, D, Ples, H, Polinder, S, Pomposo, I, Posti, J, Puybasset, L, Radoi, A, Ragauskas, A, Raj, R, Rambadagalla, M, Helmrich, I, Rhodes, J, Richardson, S, Richter, S, Ripatti, S, Rocka, S, Roise, O, Rosand, J, Rosenfeld, J, Rosenlund, C, Rosenthal, G, Rossaint, R, Rossi, S, Rueckert, D, Rusnak, M, Sahuquillo, J, Sakowitz, O, Sanchez-Porras, R, Sandor, J, Schafer, N, Schmidt, S, Schoechl, H, Schoonman, G, Schou, R, Schwendenwein, E, Sewalt, C, Singh, R, Skandsen, T, Smielewski, P, Sorinola, A, Stamatakis, E, Stanworth, S, Stevens, R, Stewart, W, Steyerberg, E, Stocchetti, N, Sundstrom, N, Takala, R, Tamas, V, Tamosuitis, T, Taylor, M, Ao, B, Theadom, A, Thomas, M, Tibboel, D, Timmers, M, Tolias, C, Trapani, T, Tudora, C, Unterberg, A, Vajkoczy, P, Vallance, S, Valeinis, E, Vamos, Z, van der Jagt, M, Van der Steen, G, van der Naalt, J, van Dijck, J, van Erp, I, van Essen, T, Van Hecke, W, van Heugten, C, Van Praag, D, van Veen, E, Vyvere, T, van Wijk, R, Vargiolu, A, Vega, E, Velt, K, Verheyden, J, Vespa, P, Vik, A, Vilcinis, R, Volovici, V, von Steinbuchel, N, Voormolen, D, Vulekovic, P, Wang, K, Whitehouse, D, Wiegers, E, Williams, G, Wilson, L, Winzeck, S, Wolf, S, Yang, Z, Ylen, P, Younsi, A, Zeiler, F, Zelinkova, V, Ziverte, A, and Zoerle, T

Subjects
Male, Mild TBI, PROM, rehabilitation, Health Policy, Rehabilitation, Glasgow Outcome Scale, Brain Injuries, Traumatic/psychology, Traumatic/psychology, SDG 3 - Good Health and Well-being, Brain Injuries, Brain Injuries/complications, Brain Injuries, Traumatic, Quality of Life, Humans, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Female, Brain Concussion
Abstract

Background Despite existing guidelines for managing mild traumatic brain injury (mTBI), evidence-based treatments are still scarce and large-scale studies on the provision and impact of specific rehabilitation services are needed. This study aimed to describe the provision of rehabilitation to patients after complicated and uncomplicated mTBI and investigate factors associated with functional outcome, symptom burden, and TBI-specific health-related quality of life (HRQOL) up to six months after injury. Methods Patients (n = 1379) with mTBI from the Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) study who reported whether they received rehabilitation services during the first six months post-injury and who participated in outcome assessments were included. Functional outcome was measured with the Glasgow Outcome Scale – Extended (GOSE), symptom burden with the Rivermead Post Concussion Symptoms Questionnaire (RPQ), and HRQOL with the Quality of Life after Brain Injury – Overall Scale (QOLIBRI-OS). We examined whether transition of care (TOC) pathways, receiving rehabilitation services, sociodemographic (incl. geographic), premorbid, and injury-related factors were associated with outcomes using regression models. For easy comparison, we estimated ordinal regression models for all outcomes where the scores were classified based on quantiles. Results Overall, 43% of patients with complicated and 20% with uncomplicated mTBI reported receiving rehabilitation services, primarily in physical and cognitive domains. Patients with complicated mTBI had lower functional level, higher symptom burden, and lower HRQOL compared to uncomplicated mTBI. Rehabilitation services at three or six months and a higher number of TOC were associated with unfavorable outcomes in all models, in addition to pre-morbid psychiatric problems. Being male and having more than 13 years of education was associated with more favorable outcomes. Sustaining major trauma was associated with unfavorable GOSE outcome, whereas living in Southern and Eastern European regions was associated with lower HRQOL. Conclusions Patients with complicated mTBI reported more unfavorable outcomes and received rehabilitation services more frequently. Receiving rehabilitation services and higher number of care transitions were indicators of injury severity and associated with unfavorable outcomes. The findings should be interpreted carefully and validated in future studies as we applied a novel analytic approach. Trial registration ClinicalTrials.gov NCT02210221.

Published
2022

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

Author

Gravesteijn, B, Sewalt, C, Ercole, A, Lecky, F, Menon, D, 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, 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, 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, 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., Gravesteijn, B, Sewalt, C, Ercole, A, Lecky, F, Menon, D, 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, 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, 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, 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., and Zoerle T.

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.

Published
2020

4. 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

6. Sigh maneuver to enhance assessment of fluid responsiveness during pressure support ventilation.

Author

Messina A, Colombo D, Barra FL, Cammarota G, De Mattei G, Longhini F, Romagnoli S, DellaCorte F, De Backer D, Cecconi M, and Navalesi P

Subjects
Aged, Airway Management trends, Area Under Curve, Female, Hemodynamics physiology, Humans, Intensive Care Units organization & administration, Italy, Male, Middle Aged, Prospective Studies, ROC Curve, Respiration, Artificial trends, Stroke Volume physiology, Airway Management methods, Fluid Therapy methods, Respiration, Artificial methods
Abstract

Background: Assessment of fluid responsiveness is problematic in intensive care unit (ICU) patients, in particular for those undergoing modes of partial support, such as pressure support ventilation (PSV). We propose a new test, based on application of a ventilator-generated sigh, to predict fluid responsiveness in ICU patients undergoing PSV., Methods: This was a prospective bi-centric interventional study conducted in two general ICUs. In 40 critically ill patients with a stable ventilatory PSV pattern and requiring volume expansion (VE), we assessed the variations in arterial systolic pressure (SAP), pulse pressure (PP) and stroke volume index (SVI) consequent to random application of 4-s sighs at three different inspiratory pressures. A radial arterial signal was directed to the MOSTCARE™ pulse contour hemodynamic monitoring system for hemodynamic measurements. Data obtained during sigh tests were recorded beat by beat, while all the hemodynamic parameters were averaged over 30 s for the remaining period of the study protocol. VE consisted of 500 mL of crystalloids over 10 min. A patient was considered a responder if a VE-induced increase in cardiac index (CI) ≥ 15% was observed., Results: The slopes for SAP, SVI and PP of were all significantly different between responders and non-responders (p < 0.0001, p = 0.0004 and p < 0.0001, respectively). The AUC of the slope of SAP (0.99; sensitivity 100.0% (79.4-100.0%) and specificity 95.8% (78.8-99.9%) was significantly greater than the AUC for PP (0.91) and SVI (0.83) (p = 0.04 and 0.009, respectively). The SAP slope best threshold value of the ROC curve was - 4.4° from baseline. The only parameter found to be independently associated with fluid responsiveness among those included in the logistic regression was the slope for SAP (p = 0.009; odds ratio 0.27 (95% confidence interval (CI 95 ) 0.10-0.70)). The effects produced by the sigh at 35 cmH 2 0 (Sigh 35 ) are significantly different between responders and non-responders. For a 35% reduction in PP from baseline, the AUC was 0.91 (CI 95 0.82-0.99), with sensitivity 75.0% and specificity 91.6%., Conclusions: In a selected ICU population undergoing PSV, analysis of the slope for SAP after the application of three successive sighs and the nadir of PP after Sigh 35 reliably predict fluid responsiveness., Trial Registration: Australian New Zealand Clinical Trials Registry, ACTRN12615001232527 . Registered on 10 November 2015.

Published
2019
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