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527 results on '"Dippel, D"'

1. ‘Value-based methodology for person-centred, integrated care supported by Information and Communication Technologies’ (ValueCare) for older people in Europe: study protocol for a pre-post controlled trial

Author

Bally, E. L. S., van Grieken, A., Ye, L., Ferrando, M., Fernández-Salido, M., Dix, R., Zanutto, O., Gallucci, M., Vasiljev, V., Carroll, A., Darley, A., Gil-Salmerón, A., Ortet, S., Rentoumis, T., Kavoulis, N., Mayora-Ibarra, O., Karanasiou, N., Koutalieris, G., Hazelzet, J. A., Roozenbeek, B., Dippel, D. W. J., and Raat, H.

Published
2022
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3. Data-efficient deep learning of radiological image data for outcome prediction after endovascular treatment of patients with acute ischemic stroke

Author

Hilbert, A., Ramos, L.A., van Os, H.J.A., Olabarriaga, S.D., Tolhuisen, M.L., Wermer, M.J.H., Barros, R.S., van der Schaaf, I., Dippel, D., Roos, Y.B.W.E.M., van Zwam, W.H., Yoo, A.J., Emmer, B.J., Lycklama à Nijeholt, G.J., Zwinderman, A.H., Strijkers, G.J., Majoie, C.B.L.M., and Marquering, H.A.

Published
2019
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5. The Effect of Non-contrast CT Slice Thickness on Thrombus Density and Perviousness Assessment

Author

Tolhuisen, M. L., Enthoven, J., Santos, E. M. M., Niessen, W. J., Beenen, L. F. M., Dippel, D. W. J., van der Lugt, A., van Zwam, W. H., Roos, Y. B. W. E. M., van Oostenbrugge, R. J., Majoie, C. B. L. M., Marquering, H. A., Hutchison, David, Series editor, Kanade, Takeo, Series editor, Kittler, Josef, Series editor, Kleinberg, Jon M., Series editor, Mattern, Friedemann, Series editor, Mitchell, John C., Series editor, Naor, Moni, Series editor, Pandu Rangan, C., Series editor, Steffen, Bernhard, Series editor, Terzopoulos, Demetri, Series editor, Tygar, Doug, Series editor, Weikum, Gerhard, Series editor, Cardoso, M. Jorge, editor, Arbel, Tal, editor, Gao, Fei, editor, Kainz, Bernhard, editor, van Walsum, Theo, editor, Shi, Kuangyu, editor, Bhatia, Kanwal K., editor, Peter, Roman, editor, Vercauteren, Tom, editor, Reyes, Mauricio, editor, Dalca, Adrian, editor, Wiest, Roland, editor, Niessen, Wiro, editor, and Emmer, Bart J., editor

Published
2017
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6. Centraal zenuwstelsel

Author

Dippel, D. W. J., Boel, M.G., editor, Machielse, P., editor, Lichtveld, R.A., editor, and Bierens, J.J.L.M., editor

Published
2017
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10. Collateral status and recanalization after endovascular treatment for acute ischemic stroke

Author

Uniken Venema, S. M., Dankbaar, J. W., Wolff, L., Van Es, A. C. G. M., Sprengers, M., Van Der Lugt, A., Dippel, D. W. J., Van Der Worp, H. B., Uniken Venema, S. M., Dankbaar, J. W., Wolff, L., Van Es, A. C. G. M., Sprengers, M., Van Der Lugt, A., Dippel, D. W. J., and Van Der Worp, H. B.

Abstract

Background: Successful recanalization and good collateral status are associated with good clinical outcomes after endovascular treatment (EVT) for acute ischemic stroke, but the relationships among them are unclear. Objective: To assess if collateral status is associated with recanalization after EVT and if collateral status modifies the association between successful recanalization and functional outcome. Methods: We retrospectively analyzed data from the MR CLEAN Registry, a multicenter prospective cohort study of patients with a proximal anterior occlusion who underwent EVT in the Netherlands. We determined collateral status with a previously validated four-point visual grading scale and defined successful recanalization as an extended Thrombolysis in Cerebral Infarction score ≥2B. Functional outcome was determined using the modified Rankin Scale score at 90 days. We assessed, with multivariable logistic regression models, the associations between (1) collateral status and successful recanalization, (2) successful recanalization and functional outcome, (3) collateral status and functional outcome. An interaction of collateral status and successful recanalization was assessed. Subgroup analyses were performed for patients treated with intravenous thrombolysis. Results: We included 2717 patients, of whom 1898 (70%) had successful recanalization. There was no relationship between collateral status and successful recanalization (adjusted common OR (95% CI) of grades 1, 2, and 3 vs 0: 1.19 (0.82 to 1.72), 1.20 (0.83 to 1.75), and 1.10 (0.74 to 1.63), respectively). Successful recanalization (acOR (95% CI): 2.15 (1.84 to 2.52)) and better collateral grades (acOR (95% CI) of grades 1, 2, and 3 vs 0: 2.12 (1.47 to 3.05), 3.46 (2.43 to 4.92), and 4.16 (2.89 to 5.99), respectively) were both associated with a shift towards better functional outcome, without an interaction between collateral status and successful recanalization. Results were similar for the subgroup of t

Published
2023

11. Prodromal Transient Ischemic Attack or Minor Stroke and Outcome in Basilar Artery Occlusion

Author

Weber, A.M., Donnan, G.A., Thijs, V., Peeters, A., de Freitas, G.R., Conforto, A.B., Miranda-Alves, M., Massaro, A., Ijäs, P., Bogoslovsky, T., Lindsberg, P.J., Weimar, C., Benemann, J., Kraywinkel, K., Haverkamp, C., Michalski, D., Weissenborn, K., Goertler, M., Kloth, A., Bitsch, A., Mieck, T., Machetanz, J., Möller, P., Huber, R., Kaendler, S., Rueckert, C., Audebert, H., Müller, R., Vatankhah, B., Pfefferkorn, T., Mayer, T.E., Szabo, K., Disque, C., Busse, O., Berger, C., Hacke, W., Schwammenthal, Y., Orion, D., Tanne, D., Bergui, M., Pozzati, E., Schonewille, W.J., Algra, A., Kappelle, L.J., Luijckx, G.J., Vroomen, P., Vergouwen, M.D., Roos, Y., Stam, J., Bienfait, P., de Leeuw, F.E., de Kort, P., Dippel, D., Baird, T., Muir, K., Pagola, J., Ribo, M., Molina, C., Gonzales, A., Gil-Peralta, A., Norrving, B., Arnold, M., Fischer, U., Gralla, J., Mattle, H., Schroth, G., Michel, P., Engelter, S.T., Wetzel, S., Lyrer, P., Gandjour, J., Michael, N., Baumgartner, R., Tettenborn, B., Hungerbuehler, H., Wijman, C.A.C., Finley Caulfield, A., Lansberg, M., Schwartz, N., Venkatasubramanian, C., Garami, Z., Bogaard, S., Yatzu, F., Grotta, J., Conforto, Adriana B., de Freitas, Gabriel R., Schonewille, Wouter J., Kappelle, L. Jaap, and Algra, Ale

Published
2015
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12. Inter-rater reliability for assessing intracranial collaterals in patients with acute ischemic stroke: comparing 29 raters and an artificial intelligence-based software

Author

Wolff, L., Su, J., Loon, D. van, Es, A. van, Doormaal, P.J. van, Majoie, C., Zwam, W. van, Dippel, D., Jenniskens, S.F.M., Lugt, A. van der, Walsum, T. van, Radiology and nuclear medicine, ACS - Atherosclerosis & ischemic syndromes, Radiology & Nuclear Medicine, Neurology, Radiology and Nuclear Medicine, ACS - Microcirculation, Amsterdam Neuroscience - Neurovascular Disorders, Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), RS: Carim - B05 Cerebral small vessel disease, and RS: Carim - B06 Imaging

Subjects
Reproducibility of results, OUTCOMES, Collateral circulation, Consensus, Ischemic stroke, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Brain Ischemia, Cerebral Angiography, Stroke, Artificial Intelligence, PERFUSION, SCORE, CT-ANGIOGRAPHY, Humans, Radiology, Nuclear Medicine and imaging, Neurology (clinical), BURDEN, Cardiology and Cardiovascular Medicine, Software, Algorithms, INTRAARTERIAL TREATMENT
Abstract

Purpose Outcome of endovascular treatment in acute ischemic stroke patients is depending on the collateral circulation maintaining blood flow to the ischemic territory. We evaluated the inter-rater reliability and accuracy of raters and an automated algorithm for assessing the collateral score (CS, range: 0–3) in acute ischemic stroke patients. Methods Baseline CTA scans with an intracranial anterior occlusion from the MR CLEAN study (n=500) were used. For each core lab CS, ten CTA scans with sufficient quality were randomly selected. After a training session in collateral scoring, all selected CTA scans were individually evaluated for a visual CS by three groups: 7 radiologists, 13 junior and 9 senior radiology residents. Two additional radiologists scored CS to be used as reference, with a third providing a CS to produce a 2 out of 3 consensus CS in case of disagreement. An automated algorithm was also used to compute CS. Inter-rater agreement was reported with intraclass correlation coefficient (ICC). Accuracy of visual and automated CS were calculated. Results 39 CTA scans were assessed (1 corrupt CTA-scan excluded). All groups showed a moderate ICC (0.689-0.780) in comparison to the reference standard. Overall human accuracy was 65± 7% and increased to 88± 5% for dichotomized CS (0–1, 2–3). Automated CS accuracy was 62%, and 90% for dichotomized CS. No significant difference in accuracy was found between groups with different levels of expertise. Conclusion After training, inter-rater reliability in collateral scoring was not influenced by experience. Automated CS performs similar to residents and radiologists in determining a collateral score.

Published
2022
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13. Outcome Prediction after Moderate and Severe Traumatic Brain Injury: External Validation of Two Established Prognostic Models in 1742 European Patients

Author

Dijkland, S, Helmrich, I, Nieboer, D, Van Der Jagt, M, Dippel, D, Menon, D, Stocchetti, N, Maas, A, Lingsma, H, Steyerberg, E, Citerio, G, Dijkland S. A., Helmrich I. R. A. R., Nieboer D., Van Der Jagt M., Dippel D. W. J., Menon D. K., Stocchetti N., Maas A. I. R., Lingsma H. F., Steyerberg E. W., Citerio G., Dijkland, S, Helmrich, I, Nieboer, D, Van Der Jagt, M, Dippel, D, Menon, D, Stocchetti, N, Maas, A, Lingsma, H, Steyerberg, E, Citerio, G, Dijkland S. A., Helmrich I. R. A. R., Nieboer D., Van Der Jagt M., Dippel D. W. J., Menon D. K., Stocchetti N., Maas A. I. R., Lingsma H. F., Steyerberg E. W., and Citerio G.

Abstract

The International Mission on Prognosis and Analysis of Clinical Trials in Traumatic Brain Injury (IMPACT) and Corticoid Randomisation After Significant Head injury (CRASH) prognostic models predict functional outcome after moderate and severe traumatic brain injury (TBI). We aimed to assess their performance in a contemporary cohort of patients across Europe. The Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) core study is a prospective, observational cohort study in patients presenting with TBI and an indication for brain computed tomography. The CENTER-TBI core cohort consists of 4509 TBI patients available for analyses from 59 centers in 18 countries across Europe and Israel. The IMPACT validation cohort included 1173 patients with GCS ≤12, age ≥14, and 6-month Glasgow Outcome Scale-Extended (GOSE) available. The CRASH validation cohort contained 1742 patients with GCS ≤14, age ≥16, and 14-day mortality or 6-month GOSE available. Performance of the three IMPACT and two CRASH model variants was assessed with discrimination (area under the receiver operating characteristic curve; AUC) and calibration (comparison of observed vs. predicted outcome rates). For IMPACT, model discrimination was good, with AUCs ranging between 0.77 and 0.85 in 1173 patients and between 0.80 and 0.88 in the broader CRASH selection (n = 1742). For CRASH, AUCs ranged between 0.82 and 0.88 in 1742 patients and between 0.66 and 0.80 in the stricter IMPACT selection (n = 1173). Calibration of the IMPACT and CRASH models was generally moderate, with calibration-in-the-large and calibration slopes ranging between-2.02 and 0.61 and between 0.48 and 1.39, respectively. The IMPACT and CRASH models adequately identify patients at high risk for mortality or unfavorable outcome, which supports their use in research settings and for benchmarking in the context of quality-of-care assessment.

Published
2021

15. Variation in Structure and Process of Care in Traumatic Brain Injury: Provider Profiles of European Neurotrauma Centers Participating in the CENTER-TBI Study

Author

Cnossen M. C., Polinder S., Lingsma H. F., Maas A. I. R., Menon D., Steyerberg E. W., 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., Barzo 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., Buckova V., Calappi E., Cameron P., Carbayo L. G., Carise E., Carpenter C., Castano-Leon A. M., Causin F., Chevallard G., Chieregato A., Citerio G., Coburn M. C., 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., Della Corte F., Depreitere B., Ding S., Dippel D., Dizdarevic K., Duliere 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., Frantzen 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., Haberg A. K., Jacobs B., Janciak I., Janssens K., Jiang J., 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., Kolumban B., Kompanje E., Kondziella D., Koskinen L. -O., Kovacs N., Kalovits 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., MacDonald S., MacFayden C., Maegele M., Majdan M., Major S., Manara A., Manhes P., Manley G., Martin D., Martino C., Maruenda A., Marechal H., Mastelova D., Mattern J., McMahon C., Melegh B., Menovsky T., Morganti-Kossmann C., Mulazzi D., Mutschler M., Muhlan H., Negru A., Nelson D., Neugebauer E., Newcombe V., Noirhomme Q., Nyiradi 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., Pili F. S., Pirinen M., Ples H., Pomposo I., Psota M., Pullens P., Puybasset L., Ragauskas A., Raj R., Rambadagalla M., Rehorcikova 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. L., Ruiz De Arcaute F., Rusnak 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., Schlosser B., Schmidt S., Schneider A., Schoechl H., Schoonman G., Schou R. F., Schwendenwein E., Scholl M., Sir O., Skandsen T., Smakman L., Smeets D., Smielewski P., Sorinola A., Stamatakis E. L., Stanworth S., Stegemann K., Steinbuchel N., Stevens R., Stewart W., Stocchetti N., Sundstrom N., Synnot A., Szabo J., Soderberg J., Taccone F. S., Tamas 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. -F. L., Tudora C. M., Vajkoczy P., Valeinis E., Van Hecke W., Van Praag D., Van Roost D., Van Vlierberghe E., Vande Vyvere T., Vanhaudenhuyse A., Vargiolu A., Vega E., Verheyden J., Vespa P. M., Vik A., Vilcinis R., Vizzino G., Vleggeert-Lankamp C., Volovici V., Vulekovic P., Vamos Z., Wade D., Wang K. K. W., Wang L., Wildschut E., Williams G., Willumsen L., Wilson A., Wilson L., Winkler M. K. L., Ylen P., Younsi A., Zaaroor M., Zhang Z., Zheng Z., Zumbo F., De Lange S., De Ruiter G. C. W., Den Boogert H., Van Dijck J., Van Essen T. A., Van Heugten C., Van Der Jagt M., Van Der Naalt J., CENTER-Tbi Invest Participants, Cnossen, M, Polinder, S, Lingsma, H, Maas, A, Menon, D, Steyerberg, E, 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, Barzo, P, Bauerfeind, U, Beer, R, Belda, F, Bellander, B, Belli, A, Bellier, R, Benali, H, Benard, T, Berardino, M, Beretta, L, Beynon, C, Bilotta, F, Binder, H, Biqiri, E, Blaabjerg, M, Borgen, L, Bouzat, P, Bragge, P, Brazinova, A, Brehar, F, Brorsson, C, Buki, A, Bullinger, M, Buckova, V, Calappi, E, Cameron, P, Carbayo, L, Carise, E, Carpenter, C, Castano-Leon, A, Causin, F, Chevallard, G, Chieregato, A, Citerio, G, Coburn, M, Coles, J, Cooper, J, Correia, M, Covic, A, Curry, N, Czeiter, E, Czosnyka, M, Dahyot-Fizelier, C, Damas, F, Damas, P, Dawes, H, De Keyser, V, Della Corte, F, Depreitere, B, Ding, S, Dippel, D, Dizdarevic, K, Duliere, G, Dzeko, A, Eapen, G, Engemann, H, Ercole, A, Esser, P, Ezer, E, Fabricius, M, Feigin, V, Feng, J, Foks, K, Fossi, F, Francony, G, Frantzen, J, Freo, U, Frisvold, S, Furmanov, A, Gagliardo, P, Galanaud, D, Gao, G, Geleijns, K, Ghuysen, A, Giraud, B, Glocker, B, Gomez, P, Grossi, F, Gruen, R, Gupta, D, Haagsma, J, Hadzic, E, Haitsma, I, Hartings, J, Helbok, R, Helseth, E, Hertle, D, Hill, S, Hoedemaekers, A, Hoefer, S, Hutchinson, P, Haberg, A, Jacobs, B, Janciak, I, Janssens, K, Jiang, J, Jones, K, Kalala, J, Kamnitsas, K, Karan, M, Karau, J, Katila, A, Kaukonen, M, Keeling, D, Kerforne, T, Ketharanathan, N, Kettunen, J, Kivisaari, R, Kolias, A, Kolumban, B, Kompanje, E, Kondziella, D, Koskinen, L, Kovacs, N, Kalovits, F, Lagares, A, Lanyon, L, Laureys, S, Lauritzen, M, Lecky, F, Ledig, C, Lefering, R, Legrand, V, Lei, J, Levi, L, Lightfoot, R, Loeckx, D, Lozano, A, Luddington, R, Luijten-Arts, C, Macdonald, S, Macfayden, C, Maegele, M, Majdan, M, Major, S, Manara, A, Manhes, P, Manley, G, Martin, D, Martino, C, Maruenda, A, Marechal, H, Mastelova, D, Mattern, J, Mcmahon, C, Melegh, B, Menovsky, T, Morganti-Kossmann, C, Mulazzi, D, Mutschler, M, Muhlan, H, Negru, A, Nelson, D, Neugebauer, E, Newcombe, V, Noirhomme, Q, Nyiradi, J, Oddo, M, Oldenbeuving, A, Oresic, M, Ortolano, F, Palotie, A, Parizel, P, Patruno, A, Payen, J, Perera, N, Perlbarg, V, Persona, P, Peul, W, Pichon, N, Piilgaard, H, Piippo, A, Pili, F, Pirinen, M, Ples, H, Pomposo, I, Psota, M, Pullens, P, Puybasset, L, Ragauskas, A, Raj, R, Rambadagalla, M, Rehorcikova, 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, Ruiz De Arcaute, F, Rusnak, 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, Schlosser, B, Schmidt, S, Schneider, A, Schoechl, H, Schoonman, G, Schou, R, Schwendenwein, E, Scholl, M, Sir, O, Skandsen, T, Smakman, L, Smeets, D, Smielewski, P, Sorinola, A, Stamatakis, E, Stanworth, S, Stegemann, K, Steinbuchel, N, Stevens, R, Stewart, W, Stocchetti, N, Sundstrom, N, Synnot, A, Szabo, J, Soderberg, J, Taccone, F, Tamas, V, Tanskanen, P, Tascu, A, Taylor, M, Te Ao, B, Tenovuo, O, Teodorani, G, Theadom, A, Thomas, M, Tibboel, D, Tolias, C, Tshibanda, J, Tudora, C, Vajkoczy, P, Valeinis, E, Van Hecke, W, Van Praag, D, Van Roost, D, Van Vlierberghe, E, Vande Vyvere, T, Vanhaudenhuyse, A, Vargiolu, A, Vega, E, Verheyden, J, Vespa, P, Vik, A, Vilcinis, R, Vizzino, G, Vleggeert-Lankamp, C, Volovici, V, Vulekovic, P, Vamos, Z, Wade, D, Wang, K, Wang, L, Wildschut, E, Williams, G, Willumsen, L, Wilson, A, Wilson, L, Winkler, M, Ylen, P, Younsi, A, Zaaroor, M, Zhang, Z, Zheng, Z, Zumbo, F, De Lange, S, De Ruiter, G, Den Boogert, H, Van Dijck, J, Van Essen, T, Van Heugten, C, Van Der Jagt, M, Van Der Naalt, J, Cnossen, M. C., Polinder, S., Lingsma, H. F., Maas, A. I. R., Menon, D., Steyerberg, E. W., 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., Barzo, 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., Buckova, V., Calappi, E., Cameron, P., Carbayo, L. G., Carise, E., Carpenter, C., Castano-Leon, A. M., Causin, F., Chevallard, G., Chieregato, A., Citerio, G., Coburn, M. C., 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., Della Corte, F., Depreitere, B., Ding, S., Dippel, D., Dizdarevic, K., Duliere, 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., Frantzen, 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., Haberg, A. K., Jacobs, B., Janciak, I., Janssens, K., Jiang, J., 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., Kolumban, B., Kompanje, E., Kondziella, D., Koskinen, L. -O., Kovacs, N., Kalovits, 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., Macdonald, S., Macfayden, C., Maegele, M., Majdan, M., Major, S., Manara, A., Manhes, P., Manley, G., Martin, D., Martino, C., Maruenda, A., Marechal, H., Mastelova, D., Mattern, J., Mcmahon, C., Melegh, B., Menovsky, T., Morganti-Kossmann, C., Mulazzi, D., Mutschler, M., Muhlan, H., Negru, A., Nelson, D., Neugebauer, E., Newcombe, V., Noirhomme, Q., Nyiradi, 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., Pili, F. S., Pirinen, M., Ples, H., Pomposo, I., Psota, M., Pullens, P., Puybasset, L., Ragauskas, A., Raj, R., Rambadagalla, M., Rehorcikova, 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. L., Ruiz De Arcaute, F., Rusnak, 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., Schlosser, B., Schmidt, S., Schneider, A., Schoechl, H., Schoonman, G., Schou, R. F., Schwendenwein, E., Scholl, M., Sir, O., Skandsen, T., Smakman, L., Smeets, D., Smielewski, P., Sorinola, A., Stamatakis, E. L., Stanworth, S., Stegemann, K., Steinbuchel, N., Stevens, R., Stewart, W., Stocchetti, N., Sundstrom, N., Synnot, A., Szabo, J., Soderberg, J., Taccone, F. S., Tamas, 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. -F. L., Tudora, C. M., Vajkoczy, P., Valeinis, E., Van Hecke, W., Van Praag, D., Van Roost, D., Van Vlierberghe, E., Vande Vyvere, T., Vanhaudenhuyse, A., Vargiolu, A., Vega, E., Verheyden, J., Vespa, P. M., Vik, A., Vilcinis, R., Vizzino, G., Vleggeert-Lankamp, C., Volovici, V., Vulekovic, P., Vamos, Z., Wade, D., Wang, K. K. W., Wang, L., Wildschut, E., Williams, G., Willumsen, L., Wilson, A., Wilson, L., Winkler, M. K. L., Ylen, P., Younsi, A., Zaaroor, M., Zhang, Z., Zheng, Z., Zumbo, F., De Lange, S., De Ruiter, G. C. W., Den Boogert, H., Van Dijck, J., Van Essen, T. A., Van Heugten, C., Van Der Jagt, M., Van Der Naalt, J., Commission of the European Communities, Molecular Neuroscience and Ageing Research (MOLAR), Menon, David [0000-0002-3228-9692], Apollo - University of Cambridge Repository, and Public Health

Subjects
Questionnaires, Comparative Effectiveness Research, Critical Care and Emergency Medicine, Medical Doctors, Neurologi, Health Care Providers, CENTER-TBI Investigators and Participants, lcsh:Medicine, Poison control, Occupational safety and health, Diagnostic Radiology, Geographical Locations, 0302 clinical medicine, Trauma Centers, Surveys and Questionnaires, Brain Injuries, Traumatic, Medicine and Health Sciences, Brain Damage, Longitudinal Studies, Prospective Studies, Israel, lcsh:Science, Tomography, Trauma Medicine, Multidisciplinary, Radiology and Imaging, traumatic brain injury, Trauma center, Hospitals, 3. Good health, Europe, Hospitalization, Professions, Intensive Care Units, Neurology, Research Design, Intracranial pressure monitoring, Medical emergency, Engineering sciences. Technology, Research Article, medicine.medical_specialty, Imaging Techniques, Traumatic brain injury, General Science & Technology, Concordance, Comparative effectiveness research, Neuroimaging, Research and Analysis Methods, 03 medical and health sciences, Diagnostic Medicine, Physicians, Injury prevention, MD Multidisciplinary, medicine, Humans, Treatment Guidelines, Survey Research, Health Care Policy, business.industry, lcsh:R, Biology and Life Sciences, 030208 emergency & critical care medicine, Length of Stay, medicine.disease, ta3124, Computed Axial Tomography, Health Care, Health Care Facilities, Family medicine, People and Places, lcsh:Q, Population Groupings, business, 030217 neurology & neurosurgery, Neuroscience
Abstract

© 2016 Cnossen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.Introduction: The strength of evidence underpinning care and treatment recommendations in traumatic brain injury (TBI) is low. Comparative effectiveness research (CER) has been proposed as a framework to provide evidence for optimal care for TBI patients. The first step in CER is to map the existing variation. The aim of current study is to quantify variation in general structural and process characteristics among centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Methods: We designed a set of 11 provider profiling questionnaires with 321 questions about various aspects of TBI care, chosen based on literature and expert opinion. After pilot testing, questionnaires were disseminated to 71 centers from 20 countries participating in the CENTER-TBI study. Reliability of questionnaires was estimated by calculating a concordance rate among 5% duplicate questions. Results: All 71 centers completed the questionnaires. Median concordance rate among duplicate questions was 0.85. The majority of centers were academic hospitals (n = 65, 92%), designated as a level I trauma center (n = 48, 68%) and situated in an urban location (n = 70, 99%). The availability of facilities for neuro-trauma care varied across centers; e.g. 40 (57%) had a dedicated neuro-intensive care unit (ICU), 36 (51%) had an in-hospital rehabilitation unit and the organization of the ICU was closed in 64% (n = 45) of the centers. In addition, we found wide variation in processes of care, such as the ICU admission policy and intracranial pressure monitoring policy among centers. Conclusion: Even among high-volume, specialized neurotrauma centers there is substantial variation in structures and processes of TBI care. This variation provides an opportunity to study effectiveness of specific aspects of TBI care and to identify best practices with CER approaches.

Published
2020
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16. Global impact of the COVID-19 pandemic on subarachnoid haemorrhage hospitalisations, aneurysm treatment and in-hospital mortality: 1-year follow-up

Author

Nguyen, Tn, Qureshi, Mm, Klein, P, Yamagami, H, Mikulik, R, Etminan, N, Abdalkader, M, Mansour, Oy, Czlonkowska, A, Lo, H, Sathya, A, Demeestere, J, Tsivgoulis, G, Sakai, N, Sedova, P, Kristoffersen, Es, Mohammaden, M, Lereis, Vp, Scollo, Sd, Ma, A, Rahman, A, Bonnet, T, Cortier, J, De Raedt, S, Lemmens, R, Ligot, N, Hidalgo, Rct, Cuervo, Dlm, Neves, Ld, Rezende, Mts, Santiago, Ib, Sirakov, A, Sirakov, S, Cora, Ea, Kelly, Me, Lavoie, P, Peeling, L, Pikula, A, Rivera, R, Chen, Hs, Chen, Ym, Fang, Hl, Bedekovic, Mr, Budincevic, H, Strossmayer, Jj, Hrabanovska, E, Jurak, L, Cabal, M, Kadlckova, J, Karpowicz, I, Palouskova, H, Reiser, M, Klecka, L, Kovar, M, Neumann, J, Rekova, P, Sramek, M, Vitkova, E, Skorna, M, Zakova, L, Sobh, K, Alpay, K, Rautio, R, Strbian, D, Gentric, Jc, Magro, E, Naggara, O, Reiner, P, Abdulazim, A, Bohmann, Fo, Boskamp, S, Gerber, Jc, Kaiser, Dpo, Kestner, Ri, Mbroh, J, Neyazi, M, Rosenkranz, M, Sani, Af, Poli, S, Thomalla, G, Karapanayiotides, T, Kargiotis, O, Koutroulou, I, Palaiodimou, L, Guerra, Jdb, Huded, V, Nagendra, S, Prajapati, C, Krishna, A, Ghoreishi, A, Ilkhchi, Rb, Jalili, J, Sabetay, Si, Abu Raya, T, Acampa, M, Longoni, M, Bigliani, Cr, Castellan, L, Ornello, R, Renieri, L, Romoli, M, Sacco, S, Sangalli, D, Vigano, M, Zini, A, Tokimura, H, Sonoda, K, Todo, K, Fukuda, H, Fujita, K, Sakaguchi, M, Uno, M, Kan, I, Kosuke, M, Kono, R, Kimura, N, Yamamoto, N, Yamamoto, R, Doijiri, R, Shindo, S, Ohara, N, Imamura, H, Ogawa, T, Uwatoko, T, Kanamaru, T, Fujinaka, T, Takenobu, Y, Toyoda, K, Matsumaru, Y, Yazawa, Y, Sugiura, Y, Baek, Jh, Sunmonu, Ta, Kwon, Ys, Lee, Yh, Seo, Kd, Sohn, Si, Chan, Yc, Zaidi, Waw, Barrientos-Prieto, J, Gongora-Rivera, F, Martinez-Marino, M, Calderon-Vallejo, A, Groppa, S, Pavel, L, Coutinho, Jm, Dippel, D, Rinkel, L, Van Dam-Nolen, Dhk, Nwazor, Eo, Al Hashimi, Am, Ahmad, S, Rashid, U, Rodriguez-Kadota, L, Vences, Ma, Yalung, Pm, Jsh, Dy, Brola, W, Dorobek, M, Karlinski, Ma, Labuz-Roszak, Bm, Lasek-Bal, A, Sienkiewicz-Jarosz, H, Staszewski, J, Sobolewski, P, Zielinska-Turek, J, Araujo, Ap, Fonseca, L, Debiec, A, Silva, Ml, Castro, P, Rocha, M, Falup-Pecurariu, Rc, Venketasubramanian, N, Mako, Gkm, Ayo-Martin, O, Wiacek, M, Blasco, J, Cruz-Culebras, A, Hernandez-Fernandez, F, Fernandez, Cr, Lopez, Je, Rodriguez, A, Bolognese, M, Karwacki, Gm, Keller, E, Machi, P, Bernava, G, Boonyakarnkul, S, Churojana, A, Hammami, N, Bajrami, A, Senadim, S, Hussain, Si, John, S, Dow, G, Krishnan, K, Lenthall, R, Wong, K, Zhang, Lq, Altschul, D, Asif, Ks, Aziz-Sultan, Ma, Bach, I, Below, K, Biller, J, Cervantes-Arslanian, Am, Chaudhry, Sa, Chebl, A, Chen, M, Colasurdo, M, Czap, A, Dasenbrock, H, Bahiru, Z, de Havenon, Ah, Dharmadhikari, S, Dmytriw, Aa, Eskey, Cj, Etherton, M, Ezepue, C, Fink, L, Gasimova, U, Goyal, N, Grimmett, Kb, Hakemi, M, Hester, T, Inoa, V, Kan, Pt, Kasper, Em, Khandelwal, P, Khatri, R, Khoury, Nn, Kim, Bs, Kolikonda, M, Kuhn, Al, Linares, G, Linfante, I, Loochtan, Ai, Lukovits, Tg, Male, Ss, Khawaja, Am, Maali, L, Galecio-Castillo, Em, Min, Jy, Mohamed, Ga, Nalleballe, K, Ortega-Gutierrez, S, Radaideh, Y, Ramakrishnan, P, Masoud, He, Reddy, Ab, Ruland, S, Omran, Ss, Sheth, Sa, Puri, As, Rahangdale, Rh, Siegler, Je, Starosciak, Ak, Tarlov, Ne, Taylor, Ra, Tsai, J, Wang, Mj, Wong, Kh, Zaidat, Oo, Hv, Le, Phan, Ht, Ton, Md, Tran, Ad, Sirakova, K, Pham, Tn, Mohlenbruch, Ma, Nagel, S, Raymond, J, Nogueira, Rg, Neurology, ACS - Atherosclerosis & ischemic syndromes, and ANS - Neurovascular Disorders

Subjects
Psychiatry and Mental health, SDG 3 - Good Health and Well-being, COVID-19, SUBARACHNOID HAEMORRHAGE, CEREBROVASCULAR DISEASE, Surgery, Neurology (clinical)
Abstract

BackgroundPrior studies indicated a decrease in the incidences of aneurysmal subarachnoid haemorrhage (aSAH) during the early stages of the COVID-19 pandemic. We evaluated differences in the incidence, severity of aSAH presentation, and ruptured aneurysm treatment modality during the first year of the COVID-19 pandemic compared with the preceding year.MethodsWe conducted a cross-sectional study including 49 countries and 187 centres. We recorded volumes for COVID-19 hospitalisations, aSAH hospitalisations, Hunt-Hess grade, coiling, clipping and aSAH in-hospital mortality. Diagnoses were identified by International Classification of Diseases, 10th Revision, codes or stroke databases from January 2019 to May 2021.ResultsOver the study period, there were 16 247 aSAH admissions, 344 491 COVID-19 admissions, 8300 ruptured aneurysm coiling and 4240 ruptured aneurysm clipping procedures. Declines were observed in aSAH admissions (−6.4% (95% CI −7.0% to −5.8%), p=0.0001) during the first year of the pandemic compared with the prior year, most pronounced in high-volume SAH and high-volume COVID-19 hospitals. There was a trend towards a decline in mild and moderate presentations of subarachnoid haemorrhage (SAH) (mild: −5% (95% CI −5.9% to –4.3%), p=0.06; moderate: −8.3% (95% CI −10.2% to –6.7%), p=0.06) but no difference in higher SAH severity. The ruptured aneurysm clipping rate remained unchanged (30.7% vs 31.2%, p=0.58), whereas ruptured aneurysm coiling increased (53.97% vs 56.5%, p=0.009). There was no difference in aSAH in-hospital mortality rate (19.1% vs 20.1%, p=0.12).ConclusionDuring the first year of the pandemic, there was a decrease in aSAH admissions volume, driven by a decrease in mild to moderate presentation of aSAH. There was an increase in the ruptured aneurysm coiling rate but neither change in the ruptured aneurysm clipping rate nor change in aSAH in-hospital mortality.Trial registration numberNCT04934020.

Published
2022

17. Estimation of treatment effects in observational stroke care data: comparison of statistical approaches

Author

Amini, M., Leeuwen, N. van, Eijkenaar, F., Graaf, R. de, Samuels, N., Oostenbrugge, R van, Wijngaard, I.R. van den, Doormaal, P.J. van, Roos, Y., Majoie, C., Roozenbeek, B., Dippel, D., Jenniskens, S.F.M., Burke, J., Lingsma, H.F., Amini, M., Leeuwen, N. van, Eijkenaar, F., Graaf, R. de, Samuels, N., Oostenbrugge, R van, Wijngaard, I.R. van den, Doormaal, P.J. van, Roos, Y., Majoie, C., Roozenbeek, B., Dippel, D., Jenniskens, S.F.M., Burke, J., and Lingsma, H.F.

Abstract

Contains fulltext : 287821.pdf (Publisher’s version ) (Open Access), INTRODUCTION: Various statistical approaches can be used to deal with unmeasured confounding when estimating treatment effects in observational studies, each with its own pros and cons. This study aimed to compare treatment effects as estimated by different statistical approaches for two interventions in observational stroke care data. PATIENTS AND METHODS: We used prospectively collected data from the MR CLEAN registry including all patients (n = 3279) with ischemic stroke who underwent endovascular treatment (EVT) from 2014 to 2017 in 17 Dutch hospitals. Treatment effects of two interventions - i.e., receiving an intravenous thrombolytic (IVT) and undergoing general anesthesia (GA) before EVT - on good functional outcome (modified Rankin Scale

Published
2022

18. Systematic Review - Combining Neuroprotection With Reperfusion in Acute Ischemic Stroke

Author

Vos, E. M., Geraedts, V. J., van der Lugt, A., Dippel, D. W. J., Wermer, M. J. H., Hofmeijer, J., van Es, A. C. G. M., Roos, Y. B. W. E. M., Peeters-Scholte, C. M. P. C. D., van den Wijngaard, I. R., Vos, E. M., Geraedts, V. J., van der Lugt, A., Dippel, D. W. J., Wermer, M. J. H., Hofmeijer, J., van Es, A. C. G. M., Roos, Y. B. W. E. M., Peeters-Scholte, C. M. P. C. D., and van den Wijngaard, I. R.

Abstract

Background: Clinical trials of neuroprotection in acute ischemic stroke (AIS) have provided disappointing results. Reperfusion may be a necessary condition for positive effects of neuroprotective treatments. This systematic review provides an overview of efficacy of neuroprotective agents in combination with reperfusion therapy in AIS. Methods: A literature search was performed on the following databases, namely PubMed, Embase, Web of Science, Cochrane Library, Emcare. All databases were searched up to September 23rd 2021. All randomized controlled trials in which patients were treated with neuroprotective strategies within 12 h of stroke onset in combination with intravenous thrombolysis (IVT), endovascular therapy (EVT), or both were included. Results: We screened 1,764 titles/abstracts and included 30 full reports of unique studies with a total of 16,160 patients. In 15 studies neuroprotectants were tested for clinical efficacy, where all patients had to receive reperfusion therapies, either IVT and/or EVT. Heterogeneity in reported outcome measures was observed. Treatment was associated with improved clinical outcome for: 1) uric acid in patients treated with EVT and IVT, 2) nerinetide in patients who underwent EVT without IVT, 3) imatinib in stroke patients treated with IVT with or without EVT, 4) remote ischemic perconditioning and IVT, and 5) high-flow normobaric oxygen treatment after EVT, with or without IVT. Conclusion: Studies specifically testing effects of neuroprotective agents in addition to IVT and/or EVT are scarce. Future neuroprotection studies should report standardized functional outcome measures and combine neuroprotective agents with reperfusion therapies in AIS or aim to include prespecified subgroup analyses for treatment with IVT and/or EVT.

Published
2022

19. Fully Automated Thrombus Segmentation on CT Images of Patients with Acute Ischemic Stroke

Author

Mojtahedi, M., Kappelhof, M., Ponomareva, E., Tolhuisen, M., Jansen, I., Bruggeman, A. A. E., Dutra, B. G., Yo, L., Lecouffe, N., Hoving, J. W., van Voorst, H., Brouwer, J., Terreros, N. A., Konduri, P., Meijer, F. J. A., Appelman, A., Treurniet, K. M., Coutinho, J. M., Roos, Y., van Zwam, W., Dippel, D., Gavves, E., Emmer, B. J., Majoie, C., Marquering, H., Mojtahedi, M., Kappelhof, M., Ponomareva, E., Tolhuisen, M., Jansen, I., Bruggeman, A. A. E., Dutra, B. G., Yo, L., Lecouffe, N., Hoving, J. W., van Voorst, H., Brouwer, J., Terreros, N. A., Konduri, P., Meijer, F. J. A., Appelman, A., Treurniet, K. M., Coutinho, J. M., Roos, Y., van Zwam, W., Dippel, D., Gavves, E., Emmer, B. J., Majoie, C., and Marquering, H.

Abstract

Thrombus imaging characteristics are associated with treatment success and functional outcomes in stroke patients. However, assessing these characteristics based on manual annotations is labor intensive and subject to observer bias. Therefore, we aimed to create an automated pipeline for consistent and fast full thrombus segmentation. We used multicenter, multi-scanner datasets of anterior circulation stroke patients with baseline NCCT and CTA for training (n = 228) and testing (n = 100). We first found the occlusion location using StrokeViewer LVO and created a bounding box around it. Subsequently, we trained dual modality U-Net based convolutional neural networks (CNNs) to segment the thrombus inside this bounding box. We experimented with: (1) U-Net with two input channels for NCCT and CTA, and U-Nets with two encoders where (2) concatenate, (3) add, and (4) weighted-sum operators were used for feature fusion. Furthermore, we proposed a dynamic bounding box algorithm to adjust the bounding box. The dynamic bounding box algorithm reduces the missed cases but does not improve Dice. The two-encoder U-Net with a weighted-sum feature fusion shows the best performance (surface Dice 0.78, Dice 0.62, and 4% missed cases). Final segmentation results have high spatial accuracies and can therefore be used to determine thrombus characteristics and potentially benefit radiologists in clinical practice.

Published
2022

20. ‘Value-based methodology for person-centred, integrated care supported by Information and Communication Technologies’ (ValueCare) for older people in Europe:study protocol for a pre-post controlled trial

Author

Bally, E. L.S., van Grieken, A., Ye, L., Ferrando, M., Fernández-Salido, M., Dix, R., Zanutto, O., Gallucci, M., Vasiljev, V., Carroll, A., Darley, A., Gil-Salmerón, A., Ortet, S., Rentoumis, T., Kavoulis, N., Mayora-Ibarra, O., Karanasiou, N., Koutalieris, G., Hazelzet, J. A., Roozenbeek, B., Dippel, D. W.J., Raat, H., Bally, E. L.S., van Grieken, A., Ye, L., Ferrando, M., Fernández-Salido, M., Dix, R., Zanutto, O., Gallucci, M., Vasiljev, V., Carroll, A., Darley, A., Gil-Salmerón, A., Ortet, S., Rentoumis, T., Kavoulis, N., Mayora-Ibarra, O., Karanasiou, N., Koutalieris, G., Hazelzet, J. A., Roozenbeek, B., Dippel, D. W.J., and Raat, H.

Abstract

Background: Older people receive care from multiple providers which often results in a lack of coordination. The Information and Communication Technology (ICT) enabled value-based methodology for integrated care (ValueCare) project aims to develop and implement efficient outcome-based, integrated health and social care for older people with multimorbidity, and/or frailty, and/or mild to moderate cognitive impairment in seven sites (Athens, Greece; Coimbra, Portugal; Cork/Kerry, Ireland; Rijeka, Croatia; Rotterdam, the Netherlands; Treviso, Italy; and Valencia, Spain). We will evaluate the implementation and the outcomes of the ValueCare approach. This paper presents the study protocol of the ValueCare project; a protocol for a pre-post controlled study in seven large-scale sites in Europe over the period between 2021 and 2023. Methods: A pre-post controlled study design including three time points (baseline, post-intervention after 12 months, and follow-up after 18 months) and two groups (intervention and control group) will be utilised. In each site, (net) 240 older people (120 in the intervention group and 120 in the control group), 50–70 informal caregivers (e.g. relatives, friends), and 30–40 health and social care practitioners will be invited to participate and provide informed consent. Self-reported outcomes will be measured in multiple domains; for older people: health, wellbeing, quality of life, lifestyle behaviour, and health and social care use; for informal caregivers and health and social care practitioners: wellbeing, perceived burden and (job) satisfaction. In addition, implementation outcomes will be measured in terms of acceptability, appropriateness, feasibility, fidelity, and costs. To evaluate differences in outcomes between the intervention and control group (multilevel) logistic and linear regression analyses will be used. Qualitative analysis will be performed on the focus group data. Discussion: This study will provide new insights into t

Published
2022

21. Association of hyperglycemia and computed tomographic perfusion deficits in patients who underwent endovascular treatment for acute ischemic stroke caused by a proximal intracranial occlusion: A subgroup analysis of a randomized phase 3 trial (MR CLEAN)

Author

Kersten, C J B A, Zandbergen, A A M, Berkhemer, O A, Borst, J, Haalboom, M, Roos, Y B W E M, Dippel, D W J, van Oostenbrugge, R J, van der Lugt, A, van Zwam, W H, Majoie, C B, den Hertog, H M, MR CLEAN Investigators, Kersten, C J B A, Zandbergen, A A M, Berkhemer, O A, Borst, J, Haalboom, M, Roos, Y B W E M, Dippel, D W J, van Oostenbrugge, R J, van der Lugt, A, van Zwam, W H, Majoie, C B, den Hertog, H M, and MR CLEAN Investigators

Abstract

INTRODUCTION: Hyperglycemia is highly prevalent in patients with acute ischemic stroke and is associated with increased risk of symptomatic intracranial hemorrhage, larger infarct size and unfavorable outcome. Furthermore, glucose may modify the effect of endovascular treatment (EVT) in patients with ischemic stroke. Hyperglycemia might lead to accelerated conversion of penumbra into infarct core. However, it remains uncertain whether hyperglycemia on admission is associated with the size of penumbra or infarct core in acute ischemic stroke. In this study, we aimed to assess the association between hyperglycemia and Computed Tomographic Perfusion (CTP) derived parameters in patients who underwent EVT for acute ischemic stroke.METHODS: We used data from the MR CLEAN study (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands). Hyperglycemia was defined as admission serum glucose of >7.8 mmol/L. Dichotomized and quantiles of glucose levels were related to size of core, penumbra and core penumbra ratio. Hypoperfused area is mean transient time 45% higher than that of the contralateral hemisphere. Core is the area with cerebral blood volume of <2 mL/100 g and penumbra is the area with cerebral blood volume > 2 mL/100 g. Core-penumbra ratio is the ischemic core divided by the total volume of hypoperfused tissue (core plus penumbra) multiplied by 100. Adjustments were made for age, sex, NIHSS on admission, onset-imaging time and diabetes mellitus.RESULTS: Hundred seventy-three patients were included. Median glucose level on admission was 6.5 mmol/L (IQR 5.8-7.5 mmol/L) and thirty-five patients (20%) were hyperglycemic. Median core volume was 33.3 mL (IQR 13.6-62.4 mL), median penumbra volume was 80.2 mL (IQR 36.3-123.5 mL) and median core-penumbra ratio was 28.5% (IQR 18.6-45.8%). Patients with hyperglycemia on admission had larger core volumes and core penumbra ratio than normoglycemic pati

Published
2022

32. Correction to: Variation in neurosurgical management of traumatic brain injury: a survey in 68 centers participating in the CENTER-TBI study (Acta Neurochirurgica, (2019), 161, 3, (435-449), 10.1007/s00701-018-3761-z)

Author

van Essen T. A., van Essen, T, den Boogert, H, Cnossen, M, de Ruiter, G, Haitsma, I, Polinder, S, Steyerberg, E, Menon, D, Maas, A, Lingsma, H, Peul, W, Ackerlund, C, Adams, H, Agnoletti, V, Allanson, J, Amrein, K, Andaluz, N, Andelic, N, Andreassen, L, Antun, A, Anke, A, Antoni, A, Ardon, H, Audibert, G, Auslands, K, Azouvi, P, Azzolini, M, Baciu, C, Badenes, R, Bartels, R, Larizza, D, Barzo, P, Bauerfeind, U, Beauvais, R, Beer, R, Belda, F, Bellander, B, Belli, A, Bellier, R, Benali, H, Benard, T, Berardino, M, Beretta, L, Beynon, C, Bilotta, F, Binder, H, Biqiri, E, Blaabjerg, M, Bouzat, P, Bragge, P, Brazinova, A, Brinck, V, Brooker, J, Brorsson, C, Buki, A, Bullinger, M, Calappi, E, Calvi, M, Cameron, P, Carbayo, L, Carbonara, M, Carise, E, Carpenter, K, Castano-Leon, A, Causin, F, Chevallard, G, Chieregato, A, Citerio, G, Coburn, M, Coles, J, Coles-Kemp, L, Collett, J, Cooper, J, Correia, M, Covic, A, Curry, N, Czeiter, E, Czosnyka, M, Dahyot-Fizelier, C, Damas, F, Damas, P, Dawes, H, De Keyser, V, Della, C, Depreitere, B, Dilvesi, D, Ding, S, Dippel, D, Dixit, A, Donoghue, E, Dreier, J, Duliere, G, Eapen, G, Engemann, H, Ercole, A, Esser, P, Ezer, E, Fabricius, M, Feigin, V, Feng, J, Foks, K, Fossi, F, Francony, G, Freo, U, Frisvold, S, Furmanov, A, Gagliardo, P, Galanaud, D, Gantner, D, Gao, G, Geleijns, K, George, P, Ghuysen, A, Giga, L, Giraud, B, Glocker, B, Golubovic, J, Gomez, P, Grossi, F, Gruen, R, Gupta, D, Haagsma, J, Hartings, J, Helbok, R, Helseth, E, Hertle, D, Hoedemaekers, A, Hoefer, S, Horton, L, Huijben, J, Hutchinson, P, Haberg, A, Jacobs, B, Jankowski, S, Jarrett, M, Jelaca, B, Jiang, J, Jones, K, Kamnitsas, K, Karan, M, Katila, A, Kaukonen, M, Kerforne, T, Kivisaari, R, Kolias, A, Kolumban, B, Kompanje, E, Kolundzija, K, Kondziella, D, Koskinen, L, Kovacs, N, Lagares, A, Lanyon, L, Laureys, S, Lecky, F, Ledig, C, Lefering, R, Legrand, V, Lei, J, Levi, L, Lightfoot, R, Loeckx, D, Lozano, A, Macdonald, S, Maegele, M, Majdan, M, Major, S, Manara, A, Manley, G, Martin, D, Martin, L, Martino, C, Maruenda, A, Marechal, H, Masala, A, Mattern, J, Mcfadyen, C, Mcmahon, C, Melegh, B, Menovsky, T, Morganti-Kossmann, C, Mulazzi, D, Muraleedharan, V, Murray, L, Muhlan, H, Nair, N, Negru, A, Nelson, D, Newcombe, V, Nieboer, D, Noirhomme, Q, Nyiradi, J, Oddo, M, Oldenbeuving, A, Oresic, M, Ortolano, F, Palotie, A, Parizel, P, Patruno, A, Payen, J, Perera, N, Perlbarg, V, Persona, P, Piippo-Karjalainen, A, Pili, F, Pirinen, M, Ples, H, Poca, M, Pomposo, I, Posti, J, Puybasset, L, Radoi, A, Ragauskas, A, Raj, R, Rambadagalla, M, Real, R, Rehorcikova, V, Rhodes, J, Ripatti, S, Rocka, S, Roe, C, Roise, O, Roks, G, Rosand, J, Rosenfeld, J, Rosenlund, C, Rosenthal, G, Rossaint, R, Rossi, S, Rueckert, D, Rusnak, M, Sacchi, M, Sahakian, B, Sahuquillo, J, Sakowitz, O, Sala, F, Sanchez-Porras, R, Sandor, J, Santos, E, Sasu, L, Savo, D, Schaffer, N, Schipper, I, Schlosser, B, Schmidt, S, Schoechl, H, Schoonman, G, Schou, R, Schwendenwein, E, Scholl, M, Sir, O, Skandsen, T, Smakman, L, Smeets, D, Smielewski, P, Sorinola, A, Stamatakis, E, Stanworth, S, Steinbuchel, N, Stevanovic, A, Stevens, R, Stewart, W, Stocchetti, N, Sundstrom, N, Synnot, A, Taccone, F, Takala, R, Tamas, V, Tanskanen, P, Taylor, M, Te Ao, B, Tenovuo, O, Telgmann, R, Teodorani, G, Theadom, A, Thomas, M, Tibboel, D, Tolias, C, Tshibanda, J, Trapani, T, Tudora, C, Vajkoczy, P, Vallance, S, Valeinis, E, Van der Steen, G, van der Jagt, M, van der Naalt, J, van Dijck, J, Van Hecke, W, van Heugten, C, Van Praag, D, Vande Vyvere, T, Van Waesberghe, J, Vanhaudenhuyse, A, Vargiolu, A, Vega, E, Velt, K, Verheyden, J, Vespa, P, Vik, A, Vilcinis, R, Vizzino, G, Vleggeert-Lankamp, C, Volovici, V, Voormolen, D, Vulekovic, P, Vamos, Z, Wade, D, Wang, K, Wang, L, Wessels, L, Wildschut, E, Williams, G, Wilson, L, Winkler, M, Wolf, S, Ylen, P, Younsi, A, Zaaroor, M, Zhihui, Y, Ziverte, A, Zumbo, F, van Essen T. A., den Boogert H. F., Cnossen M. C., de Ruiter G. C. W., Haitsma I., Polinder S., Steyerberg E. W., Menon D., Maas A. I. R., Lingsma H. F., Peul W. C., Ackerlund C., Adams H., Agnoletti V., Allanson J., Amrein K., Andaluz N., Andelic N., Andreassen L., Antun A., Anke A., Antoni A., Ardon H., Audibert G., Auslands K., Azouvi P., Azzolini M. L., Baciu C., Badenes R., Bartels R., Larizza D., Barzo P., Bauerfeind U., Beauvais R., 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., den Boogert H., Bouzat P., Bragge P., Brazinova A., Brinck V., Brooker J., Brorsson C., Buki A., Bullinger M., Calappi E., Calvi M. R., Cameron P., Carbayo L. G., Carbonara M., Carise E., Carpenter K., Castano-Leon A. M., Causin F., Chevallard G., Chieregato A., Citerio G., Cnossen M., Coburn M., Coles J., Coles-Kemp L., Collett 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., Della C. F., Depreitere B., Dilvesi D., Ding S., Dippel D., Dixit A., Donoghue E., Dreier J., Duliere G. -L., Eapen G., Engemann H., Ercole A., Esser P., Ezer E., Fabricius M., Feigin V. L., Feng J., Foks K., Fossi F., Francony G., Freo U., Frisvold S., Furmanov A., Gagliardo P., Galanaud D., Gantner D., Gao G., Geleijns K., George P., Ghuysen A., Giga L., Giraud B., Glocker B., Golubovic J., Gomez P. A., Grossi F., Gruen R. L., Gupta D., Haagsma J. A., Hartings J. A., Helbok R., Helseth E., Hertle D., Hoedemaekers A., Hoefer S., Horton L., Huijben J., Hutchinson P. J., Haberg A. K., Jacobs B., Jankowski S., Jarrett M., Jelaca B., Jiang J. -Y., Jones K., Kamnitsas K., Karan M., Katila A., Kaukonen M., Kerforne T., Kivisaari R., Kolias A. G., Kolumban B., Kompanje E., Kolundzija K., Kondziella D., Koskinen L. -O., Kovacs N., Lagares A., Lanyon L., Laureys S., Lecky F., Ledig C., Lefering R., Legrand V., Lei J., Levi L., Lightfoot R., Lingsma H., Loeckx D., Lozano A., MacDonald S., Maegele M., Majdan M., Major S., Manara A., Manley G., Martin D., Martin L. F., Martino C., Maruenda A., Marechal H., Masala A., Mattern J., McFadyen C., McMahon C., Melegh B., Menovsky T., Morganti-Kossmann C., Mulazzi D., Muraleedharan V., Murray L., Muhlan H., Nair N., Negru A., Nelson D., Newcombe V., Nieboer D., Noirhomme Q., Nyiradi 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., Piippo-Karjalainen A., Pili F. S., Pirinen M., Ples H., Poca M. A., Pomposo I., Posti J., Puybasset L., Radoi A., Ragauskas A., Raj R., Rambadagalla M., Real R., Rehorcikova V., Rhodes J., Ripatti S., Rocka S., Roe C., Roise O., Roks G., Rosand J., Rosenfeld J., Rosenlund C., Rosenthal G., Rossaint R., Rossi S., Rueckert D., Rusnak M., Sacchi M., Sahakian B., Sahuquillo J., Sakowitz O., Sala F., Sanchez-Porras R., Sandor J., Santos E., Sasu L., Savo D., Schaffer N., Schipper I., Schlosser B., Schmidt S., Schoechl H., Schoonman G., Schou R. F., Schwendenwein E., Scholl M., Sir O., Skandsen T., Smakman L., Smeets D., Smielewski P., Sorinola A., Stamatakis E., Stanworth S., Steinbuchel N., Stevanovic A., Stevens R., Stewart W., Stocchetti N., Sundstrom N., Synnot A., Taccone F. S., Takala R., Tamas V., Tanskanen P., Taylor M. S., Te Ao B., Tenovuo O., Telgmann R., Teodorani G., Theadom A., Thomas M., Tibboel D., Tolias C., Tshibanda J. -F. L., Trapani T., Tudora C. M., Vajkoczy P., Vallance S., Valeinis E., Van der Steen G., van der Jagt M., van der Naalt J., van Dijck J. T. J. M., Van Hecke W., van Heugten C., Van Praag D., Vande Vyvere T., Van Waesberghe J., Vanhaudenhuyse A., Vargiolu A., Vega E., Velt K., Verheyden J., Vespa P. M., Vik A., Vilcinis R., Vizzino G., Vleggeert-Lankamp C., Volovici V., Voormolen D., Vulekovic P., Vamos Z., Wade D., Wang K. K. W., Wang L., Wessels L., Wildschut E., Williams G., Wilson L., Winkler M. K. L., Wolf S., Ylen P., Younsi A., Zaaroor M., Zhihui Y., Ziverte A., Zumbo F., van Essen T. A., van Essen, T, den Boogert, H, Cnossen, M, de Ruiter, G, Haitsma, I, Polinder, S, Steyerberg, E, Menon, D, Maas, A, Lingsma, H, Peul, W, Ackerlund, C, Adams, H, Agnoletti, V, Allanson, J, Amrein, K, Andaluz, N, Andelic, N, Andreassen, L, Antun, A, Anke, A, Antoni, A, Ardon, H, Audibert, G, Auslands, K, Azouvi, P, Azzolini, M, Baciu, C, Badenes, R, Bartels, R, Larizza, D, Barzo, P, Bauerfeind, U, Beauvais, R, Beer, R, Belda, F, Bellander, B, Belli, A, Bellier, R, Benali, H, Benard, T, Berardino, M, Beretta, L, Beynon, C, Bilotta, F, Binder, H, Biqiri, E, Blaabjerg, M, Bouzat, P, Bragge, P, Brazinova, A, Brinck, V, Brooker, J, Brorsson, C, Buki, A, Bullinger, M, Calappi, E, Calvi, M, Cameron, P, Carbayo, L, Carbonara, M, Carise, E, Carpenter, K, Castano-Leon, A, Causin, F, Chevallard, G, Chieregato, A, Citerio, G, Coburn, M, Coles, J, Coles-Kemp, L, Collett, J, Cooper, J, Correia, M, Covic, A, Curry, N, Czeiter, E, Czosnyka, M, Dahyot-Fizelier, C, Damas, F, Damas, P, Dawes, H, De Keyser, V, Della, C, Depreitere, B, Dilvesi, D, Ding, S, Dippel, D, Dixit, A, Donoghue, E, Dreier, J, Duliere, G, Eapen, G, Engemann, H, Ercole, A, Esser, P, Ezer, E, Fabricius, M, Feigin, V, Feng, J, Foks, K, Fossi, F, Francony, G, Freo, U, Frisvold, S, Furmanov, A, Gagliardo, P, Galanaud, D, Gantner, D, Gao, G, Geleijns, K, George, P, Ghuysen, A, Giga, L, Giraud, B, Glocker, B, Golubovic, J, Gomez, P, Grossi, F, Gruen, R, Gupta, D, Haagsma, J, Hartings, J, Helbok, R, Helseth, E, Hertle, D, Hoedemaekers, A, Hoefer, S, Horton, L, Huijben, J, Hutchinson, P, Haberg, A, Jacobs, B, Jankowski, S, Jarrett, M, Jelaca, B, Jiang, J, Jones, K, Kamnitsas, K, Karan, M, Katila, A, Kaukonen, M, Kerforne, T, Kivisaari, R, Kolias, A, Kolumban, B, Kompanje, E, Kolundzija, K, Kondziella, D, Koskinen, L, Kovacs, N, Lagares, A, Lanyon, L, Laureys, S, Lecky, F, Ledig, C, Lefering, R, Legrand, V, Lei, J, Levi, L, Lightfoot, R, Loeckx, D, Lozano, A, Macdonald, S, Maegele, M, Majdan, M, Major, S, Manara, A, Manley, G, Martin, D, Martin, L, Martino, C, Maruenda, A, Marechal, H, Masala, A, Mattern, J, Mcfadyen, C, Mcmahon, C, Melegh, B, Menovsky, T, Morganti-Kossmann, C, Mulazzi, D, Muraleedharan, V, Murray, L, Muhlan, H, Nair, N, Negru, A, Nelson, D, Newcombe, V, Nieboer, D, Noirhomme, Q, Nyiradi, J, Oddo, M, Oldenbeuving, A, Oresic, M, Ortolano, F, Palotie, A, Parizel, P, Patruno, A, Payen, J, Perera, N, Perlbarg, V, Persona, P, Piippo-Karjalainen, A, Pili, F, Pirinen, M, Ples, H, Poca, M, Pomposo, I, Posti, J, Puybasset, L, Radoi, A, Ragauskas, A, Raj, R, Rambadagalla, M, Real, R, Rehorcikova, V, Rhodes, J, Ripatti, S, Rocka, S, Roe, C, Roise, O, Roks, G, Rosand, J, Rosenfeld, J, Rosenlund, C, Rosenthal, G, Rossaint, R, Rossi, S, Rueckert, D, Rusnak, M, Sacchi, M, Sahakian, B, Sahuquillo, J, Sakowitz, O, Sala, F, Sanchez-Porras, R, Sandor, J, Santos, E, Sasu, L, Savo, D, Schaffer, N, Schipper, I, Schlosser, B, Schmidt, S, Schoechl, H, Schoonman, G, Schou, R, Schwendenwein, E, Scholl, M, Sir, O, Skandsen, T, Smakman, L, Smeets, D, Smielewski, P, Sorinola, A, Stamatakis, E, Stanworth, S, Steinbuchel, N, Stevanovic, A, Stevens, R, Stewart, W, Stocchetti, N, Sundstrom, N, Synnot, A, Taccone, F, Takala, R, Tamas, V, Tanskanen, P, Taylor, M, Te Ao, B, Tenovuo, O, Telgmann, R, Teodorani, G, Theadom, A, Thomas, M, Tibboel, D, Tolias, C, Tshibanda, J, Trapani, T, Tudora, C, Vajkoczy, P, Vallance, S, Valeinis, E, Van der Steen, G, van der Jagt, M, van der Naalt, J, van Dijck, J, Van Hecke, W, van Heugten, C, Van Praag, D, Vande Vyvere, T, Van Waesberghe, J, Vanhaudenhuyse, A, Vargiolu, A, Vega, E, Velt, K, Verheyden, J, Vespa, P, Vik, A, Vilcinis, R, Vizzino, G, Vleggeert-Lankamp, C, Volovici, V, Voormolen, D, Vulekovic, P, Vamos, Z, Wade, D, Wang, K, Wang, L, Wessels, L, Wildschut, E, Williams, G, Wilson, L, Winkler, M, Wolf, S, Ylen, P, Younsi, A, Zaaroor, M, Zhihui, Y, Ziverte, A, Zumbo, F, van Essen T. A., den Boogert H. F., Cnossen M. C., de Ruiter G. C. W., Haitsma I., Polinder S., Steyerberg E. W., Menon D., Maas A. I. R., Lingsma H. F., Peul W. C., Ackerlund C., Adams H., Agnoletti V., Allanson J., Amrein K., Andaluz N., Andelic N., Andreassen L., Antun A., Anke A., Antoni A., Ardon H., Audibert G., Auslands K., Azouvi P., Azzolini M. L., Baciu C., Badenes R., Bartels R., Larizza D., Barzo P., Bauerfeind U., Beauvais R., 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., den Boogert H., Bouzat P., Bragge P., Brazinova A., Brinck V., Brooker J., Brorsson C., Buki A., Bullinger M., Calappi E., Calvi M. R., Cameron P., Carbayo L. G., Carbonara M., Carise E., Carpenter K., Castano-Leon A. M., Causin F., Chevallard G., Chieregato A., Citerio G., Cnossen M., Coburn M., Coles J., Coles-Kemp L., Collett 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., Della C. F., Depreitere B., Dilvesi D., Ding S., Dippel D., Dixit A., Donoghue E., Dreier J., Duliere G. -L., Eapen G., Engemann H., Ercole A., Esser P., Ezer E., Fabricius M., Feigin V. L., Feng J., Foks K., Fossi F., Francony G., Freo U., Frisvold S., Furmanov A., Gagliardo P., Galanaud D., Gantner D., Gao G., Geleijns K., George P., Ghuysen A., Giga L., Giraud B., Glocker B., Golubovic J., Gomez P. A., Grossi F., Gruen R. L., Gupta D., Haagsma J. A., Hartings J. A., Helbok R., Helseth E., Hertle D., Hoedemaekers A., Hoefer S., Horton L., Huijben J., Hutchinson P. J., Haberg A. K., Jacobs B., Jankowski S., Jarrett M., Jelaca B., Jiang J. -Y., Jones K., Kamnitsas K., Karan M., Katila A., Kaukonen M., Kerforne T., Kivisaari R., Kolias A. G., Kolumban B., Kompanje E., Kolundzija K., Kondziella D., Koskinen L. -O., Kovacs N., Lagares A., Lanyon L., Laureys S., Lecky F., Ledig C., Lefering R., Legrand V., Lei J., Levi L., Lightfoot R., Lingsma H., Loeckx D., Lozano A., MacDonald S., Maegele M., Majdan M., Major S., Manara A., Manley G., Martin D., Martin L. F., Martino C., Maruenda A., Marechal H., Masala A., Mattern J., McFadyen C., McMahon C., Melegh B., Menovsky T., Morganti-Kossmann C., Mulazzi D., Muraleedharan V., Murray L., Muhlan H., Nair N., Negru A., Nelson D., Newcombe V., Nieboer D., Noirhomme Q., Nyiradi 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., Piippo-Karjalainen A., Pili F. S., Pirinen M., Ples H., Poca M. A., Pomposo I., Posti J., Puybasset L., Radoi A., Ragauskas A., Raj R., Rambadagalla M., Real R., Rehorcikova V., Rhodes J., Ripatti S., Rocka S., Roe C., Roise O., Roks G., Rosand J., Rosenfeld J., Rosenlund C., Rosenthal G., Rossaint R., Rossi S., Rueckert D., Rusnak M., Sacchi M., Sahakian B., Sahuquillo J., Sakowitz O., Sala F., Sanchez-Porras R., Sandor J., Santos E., Sasu L., Savo D., Schaffer N., Schipper I., Schlosser B., Schmidt S., Schoechl H., Schoonman G., Schou R. F., Schwendenwein E., Scholl M., Sir O., Skandsen T., Smakman L., Smeets D., Smielewski P., Sorinola A., Stamatakis E., Stanworth S., Steinbuchel N., Stevanovic A., Stevens R., Stewart W., Stocchetti N., Sundstrom N., Synnot A., Taccone F. S., Takala R., Tamas V., Tanskanen P., Taylor M. S., Te Ao B., Tenovuo O., Telgmann R., Teodorani G., Theadom A., Thomas M., Tibboel D., Tolias C., Tshibanda J. -F. L., Trapani T., Tudora C. M., Vajkoczy P., Vallance S., Valeinis E., Van der Steen G., van der Jagt M., van der Naalt J., van Dijck J. T. J. M., Van Hecke W., van Heugten C., Van Praag D., Vande Vyvere T., Van Waesberghe J., Vanhaudenhuyse A., Vargiolu A., Vega E., Velt K., Verheyden J., Vespa P. M., Vik A., Vilcinis R., Vizzino G., Vleggeert-Lankamp C., Volovici V., Voormolen D., Vulekovic P., Vamos Z., Wade D., Wang K. K. W., Wang L., Wessels L., Wildschut E., Williams G., Wilson L., Winkler M. K. L., Wolf S., Ylen P., Younsi A., Zaaroor M., Zhihui Y., Ziverte A., and Zumbo F.

Abstract

The names of themembers of the IOPSMS study Group was inverted in the original paper and is now corrected in this article.

Published
2019

36. Multicenter randomized clinical trial of endovascular treatment for acute ischemic stroke. The effect of periprocedural medication: Acetylsalicylic acid, unfractionated heparin, both, or neither (MR CLEAN-MED). Rationale and study design

Author

Chalos, V, A van de Graaf, R, Roozenbeek, B, C G M van Es, A, M den Hertog, H, Staals, J, van Dijk, L, F M Jenniskens, S, J van Oostenbrugge, R, H van Zwam, W, B W E M Roos, Y, B L M Majoie, C, F Lingsma, H, van der Lugt, A, W J Dippel, D, investigators, MR CLEAN-MED, Rothwell, P, Clinical Neurophysiology, Neurology, Public Health, Radiology & Nuclear Medicine, ​Basic and Translational Research and Imaging Methodology Development in Groningen (BRIDGE), Damage and Repair in Cancer Development and Cancer Treatment (DARE), Klinische Neurowetenschappen, MUMC+: MA Med Staf Spec Neurologie (9), RS: Carim - B05 Cerebral small vessel disease, MUMC+: MA Neurologie (3), MUMC+: Hersen en Zenuw Centrum (3), Beeldvorming, MUMC+: DA BV Medisch Specialisten Radiologie (9), and RS: Carim - B06 Imaging

Subjects
Periprocedural, OCCLUSION, Cerebrovascular disorders, INTRACRANIAL HEMORRHAGE, Medicine (miscellaneous), THERAPY, Brain Ischemia, law.invention, INFORMED-CONSENT PROCEDURE, Study Protocol, Randomized controlled trial, Modified Rankin Scale, law, Antithrombotic, Occlusion, REPERFUSION, Multicenter Studies as Topic, Pharmacology (medical), Prospective Studies, Prospective cohort study, Stroke, Randomized Controlled Trials as Topic, Thrombectomy, lcsh:R5-920, Ischemic stroke, Endovascular Procedures, Heparin, Clinical equipoise, Treatment Outcome, FOCAL CEREBRAL-ISCHEMIA, Cardiology, Ischemic Stroke/drug therapy, lcsh:Medicine (General), medicine.drug, Adult, medicine.medical_specialty, Internal medicine, Acetylsalicylic acid, medicine, INJURY, Humans, NO-REFLOW, Endovascular treatment, Heparin/therapeutic use, Aspirin, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Brain Ischemia/drug therapy, medicine.disease, DEFERRED CONSENT, Aspirin/therapeutic use, business, INTRAARTERIAL TREATMENT
Abstract

Background Despite evidence of a quite large beneficial effect of endovascular treatment (EVT) for ischemic stroke caused by anterior circulation large vessel occlusion, many patients do not recover even after complete recanalization. To some extent, this may be attributable to incomplete microvascular reperfusion, which can possibly be improved by antiplatelet agents and heparin. It is unknown whether periprocedural antithrombotic medication in patients treated with EVT improves functional outcome. The aim of this study is to assess the effect of acetylsalicylic acid (ASA) and unfractionated heparin (UFH), alone, or in combination, given to patients with an ischemic stroke caused by an intracranial large vessel occlusion in the anterior circulation during EVT. Methods MR CLEAN-MED is a multicenter phase III trial with a prospective, 2 × 3 factorial randomized, open label, blinded end-point (PROBE) design, which aims to enroll 1500 patients. The trial is designed to evaluate the effect of intravenous ASA (300 mg), UFH (low or moderate dose), both or neither as adjunctive therapy to EVT. We enroll adult patients with a clinical diagnosis of stroke (NIHSS ≥ 2) and with a confirmed intracranial large vessel occlusion in the anterior circulation on CTA or MRA, when EVT within 6 h from symptom onset is indicated and possible. The primary outcome is the score on the modified Rankin Scale (mRS) at 90 days. Treatment effect on the mRS will be estimated with ordinal logistic regression analysis, with adjustment for main prognostic variables. Secondary outcomes include stroke severity measured with the NIHSS at 24 h and at 5–7 days, follow-up infarct volume, symptomatic intracranial hemorrhage (sICH), and mortality. Discussion Clinical equipoise exists whether antithrombotic medication should be administered during EVT for a large vessel occlusion, as ASA and/or UFH may improve functional outcome, but might also lead to an increased risk of sICH. When one or both of the study treatments show the anticipated effect on outcome, we will be able to improve outcome of patients treated with EVT by 5%. This amounts to more than 50 patients annually in the Netherlands, more than 1800 in Europe, and more than 1300 in the USA. Trial registration ISRCT, ISRCTN76741621. Dec 6, 2017.

Published
2020

37. Posttreatment Ischemic Lesion Evolution Is Associated With Reduced Favorable Functional Outcome in Patients With Stroke

Author

Konduri, P., van Voorst, H., Bucker, A., van Kranendonk, K., Boers, A., Treurniet, K., Berkhemer, O., Yoo, A.J., van Zwam, W., van Oostenbrugge, R., van der Lugt, A., Dippel, D., Roos, Y., Bot, J., Majoie, C., Marquering, H., MR CLEAN Trial Investigators, Konduri, P., van Voorst, H., Bucker, A., van Kranendonk, K., Boers, A., Treurniet, K., Berkhemer, O., Yoo, A.J., van Zwam, W., van Oostenbrugge, R., van der Lugt, A., Dippel, D., Roos, Y., Bot, J., Majoie, C., Marquering, H., and MR CLEAN Trial Investigators

Abstract

Background and Purpose: Ischemic lesion volume can increase even 24 hours after onset of an acute ischemic stroke. In this study, we investigated the association of lesion evolution with functional outcome and the influence of successful recanalization on this association. Methods: We included patients from the MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) who received good quality noncontrast CT images 24 hours and 1 week after stroke onset. The ischemic lesion delineations included infarct, edema, and hemorrhagic transformation. Lesion evolution was defined as the difference between the volumes measured on the 1-week and 24-hour noncontrast CTs. The association of lesion evolution with functional outcome was evaluated using unadjusted and adjusted logistic regression. Adjustments were made for baseline, clinical, and imaging parameters that were associated P<0.10) in univariate analysis with favorable functional outcome, defined as modified Rankin Scale score of <= 2. Interaction analysis was performed to evaluate the influence of successful recanalization, defined as modified Arterial Occlusion Lesion score of 3 points, on this association. Results: Of the 226 patients who were included, 69 (31%) patients achieved the favorable functional outcome. Median lesion evolution was 22 (interquartile range, 10-45) mL. Lesion evolution was significantly inversely correlated with favourable functional outcome: unadjusted odds ratio, 0.76 (95% CI, 0.66-0.86; per 10 mL of lesion evolution; P<0.01) and adjusted odds ratio: 0.85 (95% CI, 0.72-0.97; per 10 mL of lesion evolution; P=0.03). There was no significant interaction of successful recanalization on the association of lesion evolution and favorable functional outcome (odds ratio, 1.01 [95% CI, 0.77-1.36]; P=0.94). Conclusions: In our population, subacute ischemic lesion evolution is associated with unfavorable functional outcome. Thi

Published
2021

38. Fluid balance and outcome in critically ill patients with traumatic brain injury (CENTER-TBI and OzENTER-TBI): a prospective, multicentre, comparative effectiveness study

Author

Wiegers, E, Lingsma, H, Huijben, J, Cooper, D, Citerio, G, Frisvold, S, Helbok, R, Maas, A, Menon, D, Moore, E, Stocchetti, N, Dippel, D, Steyerberg, E, van der Jagt, M, Brooker, J, Bragge, P, Rosenfeld, J, Cooper, J, Beer, R, Schoechl, H, Rusnák, M, Schwendenwein, E, Antoni, A, De Keyser, V, Menovsky, T, Van Praag, D, Van der Steen, G, Parizel, P, Vande Vyvere, T, Depreitere, B, Van Hecke, W, Verheyden, J, Misset, B, Ledoux, D, Laureys, S, Ghuysen, A, Maréchal, H, Dulière, G, Gao, G, Jiang, J, Kondziella, D, Fabricius, M, Schou, R, Blaabjerg, M, Rosenlund, C, Piippo-Karjalainen, A, Raj, R, Pirinen, M, Ripatti, S, Palotie, A, Ylén, P, Posti, J, Tenovuo, O, Takala, R, Payen, J, Vega, E, Lejeune, A, Audibert, G, Degos, V, Benali, H, Galanaud, D, Perlbarg, V, Puybasset, L, Azouvi, P, Legrand, V, Dahyot-Fizelier, C, Rossaint, R, Coburn, M, Kowark, A, Clusmann, H, Dreier, J, Wolf, S, Vajkoczy, P, Maegele, M, Gratz, J, Schäfer, N, Lefering, R, Covic, A, von Steinbüchel, N, Schmidt, S, Bullinger, M, Younsi, A, Unterberg, A, Mattern, J, Sakowitz, O, Sanchez-Porras, R, Perera, N, Beauvais, R, Sandor, J, Czeiter, E, Buki, A, Ezer, E, Vámos, Z, Melegh, B, Tamás, V, Sorinola, A, Kovács, N, Nyirádi, J, Amrein, K, Barzó, P, Gupta, D, Levi, L, Rosenthal, G, Furmanov, A, Martino, C, Beretta, L, Calvi, M, Azzolini, M, Calappi, E, Zoerle, T, Ortolano, F, Carbonara, M, Caccioppola, A, Vargiolu, A, Chieregato, A, Chevallard, G, Della Corte, F, Grossi, F, Rossi, S, Persona, P, Berardino, M, Cavallo, S, Rambadagalla, M, Ziverte, A, Giga, L, Valeinis, E, Vilcinis, R, Tamosuitis, T, Rocka, S, Ragauskas, A, van der Naalt, J, Jacobs, B, Bartels, R, den Boogert, H, Kompanje, E, Timmers, M, Foks, K, Haitsma, I, Volovici, V, Haagsma, J, Mikolic, A, Velt, K, Voormolen, D, Nieboer, D, Sewalt, C, Gravesteijn, B, Polinder, S, Tibboel, D, van Wijk, R, van Dijck, J, van Essen, T, Peul, W, Schoonman, G, Jones, K, Feigin, V, Te Ao, B, Theadom, A, Helseth, E, Roe, C, Roise, O, Andelic, N, Andreassen, L, Anke, A, Vik, A, Skandsen, T, Ples, H, Tudora, C, Negru, A, Vulekovic, P, Đilvesi, Đ, Karan, M, Golubovic, J, Rehorcíková, V, Taylor, M, Brazinova, A, Majdan, M, Sahuquillo, J, Radoi, A, Carbayo Lozano, G, Pomposo, I, Lagares, A, Gomez, P, Castaño-León, A, Gagliardo, P, Oresic, M, Bellander, B, Lanyon, L, George, P, Muraleedharan, V, Nelson, D, Ackerlund, C, Koskinen, L, Sundström, N, Brorsson, C, Belli, A, Manara, A, Thomas, M, Czosnyka, M, Smielewski, P, Cabeleira, M, Coles, J, Richardson, S, Zeiler, F, Stamatakis, E, Williams, G, Ercole, A, Dixit, A, Newcombe, V, Richter, S, Mcfadyen, C, Hutchinson, P, Kolias, A, Adams, H, Correia, M, Rhodes, J, Stewart, W, Mcmahon, C, Rueckert, D, Glocker, B, Tolias, C, Dawes, H, Esser, P, van Heugten, C, Curry, N, Stanworth, S, Lecky, F, Otesile, O, Johnson, F, Dark, P, Jankowski, S, Lightfoot, R, Wilson, L, Horton, L, Stevens, R, Rosand, J, Manley, G, Jarrett, M, Brinck, V, Wang, K, Yang, Z, Vespa, P, Gruen, R, Cameron, P, Donoghue, E, Gantner, D, Murray, L, Varma, D, Trapani, T, Vallance, S, Macisaac, C, Jordan, A, Wiegers, Eveline Janine Anna, Lingsma, Hester Floor, Huijben, Jilske Antonia, Cooper, David James, Citerio, Giuseppe, Frisvold, Shirin, Helbok, Raimund, Maas, Andrew Ian Ramsay, Menon, David Krishna, Moore, Elizabeth Madeleine, Stocchetti, Nino, Dippel, Diederik Willem, Steyerberg, Ewout Willem, van der Jagt, Mathieu, Brooker, Joanne, Bragge, Peter, Rosenfeld, Jeffrey, Cooper, Jamie D., Beer, Ronny, Schoechl, Herbert, Rusnák, Martin, Schwendenwein, Elisabeth, Antoni, Anna, De Keyser, Véronique, Menovsky, Tomas, Van Praag, Dominique, Maas, Andrew I. R., Van der Steen, Gregory, Parizel, Paul M., Vande Vyvere, Thijs, Depreitere, Bart, Van Hecke, Wim, Verheyden, Jan, Misset, Benoit, Ledoux, Didier, Laureys, Steven, Ghuysen, Alexandre, Maréchal, Hugues, Dulière, Guy-Loup, Gao, Guoyi, Jiang, Ji-yao, Kondziella, Daniel, Fabricius, Martin, Schou, Rico Frederik, Blaabjerg, Morten, Rosenlund, Christina, Piippo-Karjalainen, Anna, Raj, Rahul, Pirinen, Matti, Ripatti, Samuli, Palotie, Aarno, Ylén, Peter, Posti, Jussi P., Tenovuo, Olli, Takala, Riikka, Payen, Jean-François, Vega, Emmanuel, Lejeune, Aurelie, Audibert, Gérard, Degos, Vincent, Benali, Habib, Galanaud, Damien, Perlbarg, Vincent, Puybasset, Louis, Azouvi, Philippe, Legrand, Valerie, Dahyot-Fizelier, Claire, Rossaint, Rolf, Coburn, Mark Steven, Kowark, Ana, Clusmann, Hans, Dreier, Jens, Wolf, Stefan, Vajkoczy, Peter, Maegele, Marc, Gratz, Johannes, Schäfer, Nadine, Lefering, Rolf, Covic, Amra, von Steinbüchel, Nicole, Schmidt, Silke, Bullinger, Monika, Younsi, Alexander, Unterberg, Andreas, Mattern, Julia, Sakowitz, Oliver, Sanchez-Porras, Renan, Perera, Natascha, Beauvais, Romuald, Sandor, Janos, Czeiter, Endre, Buki, Andras, Ezer, Erzsébet, Vámos, Zoltán, Melegh, Béla, Tamás, Viktória, Sorinola, Abayomi, Kovács, Noémi, Nyirádi, József, Amrein, Krisztina, Barzó, Pál, Gupta, Deepak, Levi, Leon, Rosenthal, Guy, Furmanov, Alex, Martino, Costanza, Beretta, Luigi, Calvi, Maria Rosa, Azzolini, Maria Luisa, Calappi, Emiliana, Zoerle, Tommaso, Ortolano, Fabrizio, Carbonara, Marco, Caccioppola, Alessio, Vargiolu, Alessia, Chieregato, Arturo, Chevallard, Giorgio, Della Corte, Francesco, Grossi, Francesca, Rossi, Sandra, Persona, Paolo, Berardino, Maurizio, Cavallo, Simona, Rambadagalla, Malinka, Ziverte, Agate, Giga, Lelde, Valeinis, Egils, Vilcinis, Rimantas, Tamosuitis, Tomas, Rocka, Saulius, Ragauskas, Arminas, van der Naalt, Joukje, Jacobs, Bram, Steyerberg, Ewout W., Bartels, Ronald, den Boogert, Hugo, Kompanje, Erwin, Timmers, Marjolijn, Foks, Kelly, Haitsma, Iain, Volovici, Victor, Haagsma, Juanita A., Mikolic, Ana, Lingsma, Hester, Velt, Kimberley, Huijben, Jilske, Voormolen, Daphne, Nieboer, Daan, Wiegers, Eveline, Sewalt, Charlie, Gravesteijn, Benjamin, Polinder, Suzanne, Tibboel, Dick, van Wijk, Roel, van Dijck, Jeroen T. J. M., van Essen, Thomas A., Peul, Wilco, Schoonman, Guus, Jones, Kelly, Feigin, Valery L., Te Ao, Braden, Theadom, Alice, Helseth, Eirik, Roe, Cecilie, Roise, Olav, Andelic, Nada, Andreassen, Lasse, Anke, Audny, Vik, Anne, Skandsen, Toril, Ples, Horia, Tudora, Cristina Maria, Negru, Ancuta, Vulekovic, Peter, Đilvesi, Đula, Karan, Mladen, Golubovic, Jagoš, Rehorcíková, Veronika, Taylor, Mark Steven, Brazinova, Alexandra, Majdan, Marek, Sahuquillo, Juan, Radoi, Andreea, Carbayo Lozano, Guillermo, Pomposo, Inigo, Lagares, Alfonso, Gomez, Pedro A., Castaño-León, Ana M., Gagliardo, Pablo, Oresic, Matej, Bellander, Bo-Michael, Lanyon, Linda, George, Pradeep, Muraleedharan, Visakh, Nelson, David, Ackerlund, Cecilia, Koskinen, Lars-Owe, Sundström, Nina, Brorsson, Camilla, Belli, Antonio, Manara, Alex, Thomas, Matt, Czosnyka, Marek, Smielewski, Peter, Cabeleira, Manuel, Coles, Jonathan, Richardson, Sylvia, Zeiler, Frederick A., Stamatakis, Emmanuel, Williams, Guy, Menon, David, Ercole, Ari, Dixit, Abhishek, Newcombe, Virginia, Richter, Sophie, McFadyen, Charles, Hutchinson, Peter J., Kolias, Angelos G., Adams, Hadie, Correia, Marta, Rhodes, Jonathan, Stewart, William, McMahon, Catherine, Rueckert, Daniel, Glocker, Ben, Tolias, Christos, Dawes, Helen, Esser, Patrick, van Heugten, Caroline, Curry, Nicola, Stanworth, Simon, Lecky, Fiona, Otesile, Olubukola, Johnson, Faye, Dark, Paul, Jankowski, Stefan, Lightfoot, Roger, Wilson, Lindsay, Horton, Lindsay, Stevens, Robert, Rosand, Jonathan, Manley, Geoffrey, Jarrett, Mike, Brinck, Vibeke, Wang, Kevin K. W., Yang, Zhihui, Vespa, Paul M., Gruen, Russell L., Cameron, Peter, Donoghue, Emma, Gantner, Dashiell, Gruen, Russel, Murray, Lynette, Rosenfeld, Jeffrey V., Varma, Dinesh, Trapani, Tony, Vallance, Shirley, MacIsaac, Cristopher, Jordan, Andrea, Wiegers, E, Lingsma, H, Huijben, J, Cooper, D, Citerio, G, Frisvold, S, Helbok, R, Maas, A, Menon, D, Moore, E, Stocchetti, N, Dippel, D, Steyerberg, E, van der Jagt, M, Brooker, J, Bragge, P, Rosenfeld, J, Cooper, J, Beer, R, Schoechl, H, Rusnák, M, Schwendenwein, E, Antoni, A, De Keyser, V, Menovsky, T, Van Praag, D, Van der Steen, G, Parizel, P, Vande Vyvere, T, Depreitere, B, Van Hecke, W, Verheyden, J, Misset, B, Ledoux, D, Laureys, S, Ghuysen, A, Maréchal, H, Dulière, G, Gao, G, Jiang, J, Kondziella, D, Fabricius, M, Schou, R, Blaabjerg, M, Rosenlund, C, Piippo-Karjalainen, A, Raj, R, Pirinen, M, Ripatti, S, Palotie, A, Ylén, P, Posti, J, Tenovuo, O, Takala, R, Payen, J, Vega, E, Lejeune, A, Audibert, G, Degos, V, Benali, H, Galanaud, D, Perlbarg, V, Puybasset, L, Azouvi, P, Legrand, V, Dahyot-Fizelier, C, Rossaint, R, Coburn, M, Kowark, A, Clusmann, H, Dreier, J, Wolf, S, Vajkoczy, P, Maegele, M, Gratz, J, Schäfer, N, Lefering, R, Covic, A, von Steinbüchel, N, Schmidt, S, Bullinger, M, Younsi, A, Unterberg, A, Mattern, J, Sakowitz, O, Sanchez-Porras, R, Perera, N, Beauvais, R, Sandor, J, Czeiter, E, Buki, A, Ezer, E, Vámos, Z, Melegh, B, Tamás, V, Sorinola, A, Kovács, N, Nyirádi, J, Amrein, K, Barzó, P, Gupta, D, Levi, L, Rosenthal, G, Furmanov, A, Martino, C, Beretta, L, Calvi, M, Azzolini, M, Calappi, E, Zoerle, T, Ortolano, F, Carbonara, M, Caccioppola, A, Vargiolu, A, Chieregato, A, Chevallard, G, Della Corte, F, Grossi, F, Rossi, S, Persona, P, Berardino, M, Cavallo, S, Rambadagalla, M, Ziverte, A, Giga, L, Valeinis, E, Vilcinis, R, Tamosuitis, T, Rocka, S, Ragauskas, A, van der Naalt, J, Jacobs, B, Bartels, R, den Boogert, H, Kompanje, E, Timmers, M, Foks, K, Haitsma, I, Volovici, V, Haagsma, J, Mikolic, A, Velt, K, Voormolen, D, Nieboer, D, Sewalt, C, Gravesteijn, B, Polinder, S, Tibboel, D, van Wijk, R, van Dijck, J, van Essen, T, Peul, W, Schoonman, G, Jones, K, Feigin, V, Te Ao, B, Theadom, A, Helseth, E, Roe, C, Roise, O, Andelic, N, Andreassen, L, Anke, A, Vik, A, Skandsen, T, Ples, H, Tudora, C, Negru, A, Vulekovic, P, Đilvesi, Đ, Karan, M, Golubovic, J, Rehorcíková, V, Taylor, M, Brazinova, A, Majdan, M, Sahuquillo, J, Radoi, A, Carbayo Lozano, G, Pomposo, I, Lagares, A, Gomez, P, Castaño-León, A, Gagliardo, P, Oresic, M, Bellander, B, Lanyon, L, George, P, Muraleedharan, V, Nelson, D, Ackerlund, C, Koskinen, L, Sundström, N, Brorsson, C, Belli, A, Manara, A, Thomas, M, Czosnyka, M, Smielewski, P, Cabeleira, M, Coles, J, Richardson, S, Zeiler, F, Stamatakis, E, Williams, G, Ercole, A, Dixit, A, Newcombe, V, Richter, S, Mcfadyen, C, Hutchinson, P, Kolias, A, Adams, H, Correia, M, Rhodes, J, Stewart, W, Mcmahon, C, Rueckert, D, Glocker, B, Tolias, C, Dawes, H, Esser, P, van Heugten, C, Curry, N, Stanworth, S, Lecky, F, Otesile, O, Johnson, F, Dark, P, Jankowski, S, Lightfoot, R, Wilson, L, Horton, L, Stevens, R, Rosand, J, Manley, G, Jarrett, M, Brinck, V, Wang, K, Yang, Z, Vespa, P, Gruen, R, Cameron, P, Donoghue, E, Gantner, D, Murray, L, Varma, D, Trapani, T, Vallance, S, Macisaac, C, Jordan, A, Wiegers, Eveline Janine Anna, Lingsma, Hester Floor, Huijben, Jilske Antonia, Cooper, David James, Citerio, Giuseppe, Frisvold, Shirin, Helbok, Raimund, Maas, Andrew Ian Ramsay, Menon, David Krishna, Moore, Elizabeth Madeleine, Stocchetti, Nino, Dippel, Diederik Willem, Steyerberg, Ewout Willem, van der Jagt, Mathieu, Brooker, Joanne, Bragge, Peter, Rosenfeld, Jeffrey, Cooper, Jamie D., Beer, Ronny, Schoechl, Herbert, Rusnák, Martin, Schwendenwein, Elisabeth, Antoni, Anna, De Keyser, Véronique, Menovsky, Tomas, Van Praag, Dominique, Maas, Andrew I. R., Van der Steen, Gregory, Parizel, Paul M., Vande Vyvere, Thijs, Depreitere, Bart, Van Hecke, Wim, Verheyden, Jan, Misset, Benoit, Ledoux, Didier, Laureys, Steven, Ghuysen, Alexandre, Maréchal, Hugues, Dulière, Guy-Loup, Gao, Guoyi, Jiang, Ji-yao, Kondziella, Daniel, Fabricius, Martin, Schou, Rico Frederik, Blaabjerg, Morten, Rosenlund, Christina, Piippo-Karjalainen, Anna, Raj, Rahul, Pirinen, Matti, Ripatti, Samuli, Palotie, Aarno, Ylén, Peter, Posti, Jussi P., Tenovuo, Olli, Takala, Riikka, Payen, Jean-François, Vega, Emmanuel, Lejeune, Aurelie, Audibert, Gérard, Degos, Vincent, Benali, Habib, Galanaud, Damien, Perlbarg, Vincent, Puybasset, Louis, Azouvi, Philippe, Legrand, Valerie, Dahyot-Fizelier, Claire, Rossaint, Rolf, Coburn, Mark Steven, Kowark, Ana, Clusmann, Hans, Dreier, Jens, Wolf, Stefan, Vajkoczy, Peter, Maegele, Marc, Gratz, Johannes, Schäfer, Nadine, Lefering, Rolf, Covic, Amra, von Steinbüchel, Nicole, Schmidt, Silke, Bullinger, Monika, Younsi, Alexander, Unterberg, Andreas, Mattern, Julia, Sakowitz, Oliver, Sanchez-Porras, Renan, Perera, Natascha, Beauvais, Romuald, Sandor, Janos, Czeiter, Endre, Buki, Andras, Ezer, Erzsébet, Vámos, Zoltán, Melegh, Béla, Tamás, Viktória, Sorinola, Abayomi, Kovács, Noémi, Nyirádi, József, Amrein, Krisztina, Barzó, Pál, Gupta, Deepak, Levi, Leon, Rosenthal, Guy, Furmanov, Alex, Martino, Costanza, Beretta, Luigi, Calvi, Maria Rosa, Azzolini, Maria Luisa, Calappi, Emiliana, Zoerle, Tommaso, Ortolano, Fabrizio, Carbonara, Marco, Caccioppola, Alessio, Vargiolu, Alessia, Chieregato, Arturo, Chevallard, Giorgio, Della Corte, Francesco, Grossi, Francesca, Rossi, Sandra, Persona, Paolo, Berardino, Maurizio, Cavallo, Simona, Rambadagalla, Malinka, Ziverte, Agate, Giga, Lelde, Valeinis, Egils, Vilcinis, Rimantas, Tamosuitis, Tomas, Rocka, Saulius, Ragauskas, Arminas, van der Naalt, Joukje, Jacobs, Bram, Steyerberg, Ewout W., Bartels, Ronald, den Boogert, Hugo, Kompanje, Erwin, Timmers, Marjolijn, Foks, Kelly, Haitsma, Iain, Volovici, Victor, Haagsma, Juanita A., Mikolic, Ana, Lingsma, Hester, Velt, Kimberley, Huijben, Jilske, Voormolen, Daphne, Nieboer, Daan, Wiegers, Eveline, Sewalt, Charlie, Gravesteijn, Benjamin, Polinder, Suzanne, Tibboel, Dick, van Wijk, Roel, van Dijck, Jeroen T. J. M., van Essen, Thomas A., Peul, Wilco, Schoonman, Guus, Jones, Kelly, Feigin, Valery L., Te Ao, Braden, Theadom, Alice, Helseth, Eirik, Roe, Cecilie, Roise, Olav, Andelic, Nada, Andreassen, Lasse, Anke, Audny, Vik, Anne, Skandsen, Toril, Ples, Horia, Tudora, Cristina Maria, Negru, Ancuta, Vulekovic, Peter, Đilvesi, Đula, Karan, Mladen, Golubovic, Jagoš, Rehorcíková, Veronika, Taylor, Mark Steven, Brazinova, Alexandra, Majdan, Marek, Sahuquillo, Juan, Radoi, Andreea, Carbayo Lozano, Guillermo, Pomposo, Inigo, Lagares, Alfonso, Gomez, Pedro A., Castaño-León, Ana M., Gagliardo, Pablo, Oresic, Matej, Bellander, Bo-Michael, Lanyon, Linda, George, Pradeep, Muraleedharan, Visakh, Nelson, David, Ackerlund, Cecilia, Koskinen, Lars-Owe, Sundström, Nina, Brorsson, Camilla, Belli, Antonio, Manara, Alex, Thomas, Matt, Czosnyka, Marek, Smielewski, Peter, Cabeleira, Manuel, Coles, Jonathan, Richardson, Sylvia, Zeiler, Frederick A., Stamatakis, Emmanuel, Williams, Guy, Menon, David, Ercole, Ari, Dixit, Abhishek, Newcombe, Virginia, Richter, Sophie, McFadyen, Charles, Hutchinson, Peter J., Kolias, Angelos G., Adams, Hadie, Correia, Marta, Rhodes, Jonathan, Stewart, William, McMahon, Catherine, Rueckert, Daniel, Glocker, Ben, Tolias, Christos, Dawes, Helen, Esser, Patrick, van Heugten, Caroline, Curry, Nicola, Stanworth, Simon, Lecky, Fiona, Otesile, Olubukola, Johnson, Faye, Dark, Paul, Jankowski, Stefan, Lightfoot, Roger, Wilson, Lindsay, Horton, Lindsay, Stevens, Robert, Rosand, Jonathan, Manley, Geoffrey, Jarrett, Mike, Brinck, Vibeke, Wang, Kevin K. W., Yang, Zhihui, Vespa, Paul M., Gruen, Russell L., Cameron, Peter, Donoghue, Emma, Gantner, Dashiell, Gruen, Russel, Murray, Lynette, Rosenfeld, Jeffrey V., Varma, Dinesh, Trapani, Tony, Vallance, Shirley, MacIsaac, Cristopher, and Jordan, Andrea

Abstract

Background: Fluid therapy—the administration of fluids to maintain adequate organ tissue perfusion and oxygenation—is essential in patients admitted to the intensive care unit (ICU) with traumatic brain injury. We aimed to quantify the variability in fluid management policies in patients with traumatic brain injury and to study the effect of this variability on patients' outcomes. Methods: We did a prospective, multicentre, comparative effectiveness study of two observational cohorts: CENTER-TBI in Europe and OzENTER-TBI in Australia. Patients from 55 hospitals in 18 countries, aged 16 years or older with traumatic brain injury requiring a head CT, and admitted to the ICU were included in this analysis. We extracted data on demographics, injury, and clinical and treatment characteristics, and calculated the mean daily fluid balance (difference between fluid input and loss) and mean daily fluid input during ICU stay per patient. We analysed the association of fluid balance and input with ICU mortality and functional outcome at 6 months, measured by the Glasgow Outcome Scale Extended (GOSE). Patient-level analyses relied on adjustment for key characteristics per patient, whereas centre-level analyses used the centre as the instrumental variable. Findings: 2125 patients enrolled in CENTER-TBI and OzENTER-TBI between Dec 19, 2014, and Dec 17, 2017, were eligible for inclusion in this analysis. The median age was 50 years (IQR 31 to 66) and 1566 (74%) of patients were male. The median of the mean daily fluid input ranged from 1·48 L (IQR 1·12 to 2·09) to 4·23 L (3·78 to 4·94) across centres. The median of the mean daily fluid balance ranged from −0·85 L (IQR −1·51 to −0·49) to 1·13 L (0·99 to 1·37) across centres. In patient-level analyses, a mean positive daily fluid balance was associated with higher ICU mortality (odds ratio [OR] 1·10 [95% CI 1·07 to 1·12] per 0·1 L increase) and worse functional outcome (1·04 [1·02 to 1·05] per 0·1 L increase); higher mean daily flui

Published
2021

43. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research

Author

Maas, A, Menon, D, Adelson, P, Andelic, N, Bell, M, Belli, A, Bragge, P, Brazinova, A, Büki, A, Chesnut, R, CITERIO, GIUSEPPE, Coburn, M, Cooper, D, Crowder, A, Czeiter, E, Czosnyka, M, Diaz arrastia, R, Dreier, J, Duhaime, A, Ercole, A, Van Essen, T, Feigin, V, Gao, G, Giacino, J, Gonzalez lara, L, Gruen, R, Gupta, D, Hartings, J, Hill, S, Jiang, J, Ketharanathan, N, Kompanje, E, Lanyon, L, Laureys, S, Lecky, F, Levin, H, Lingsma, H, Maegele, M, Majdan, M, Manley, G, Marsteller, J, Mascia, L, Mcfadyen, C, Mondello, S, Newcombe, V, Palotie, A, Parizel, P, Peul, W, Piercy, J, Polinder, S, Puybasset, L, Rasmussen, T, Rossaint, R, Smielewski, P, Söderberg, J, Stanworth, S, Stein, M, Von Steinbüchel, N, Stewart, W, Steyerberg, E, Stocchetti, N, Synnot, A, Te Ao, B, Tenovuo, O, Theadom, A, Tibboel, D, Videtta, W, Wang, K, Williams, W, Wilson, L, Yaffe, K, Adams, H, Agnoletti, V, Allanson, J, Amrein, K, Andaluz, N, Anke, A, Antoni, A, Van As, A, Audibert, G, Azaševac, A, Azouvi, P, Azzolini, M, Baciu, C, Badenes, R, Barlow, K, Bartels, R, Bauerfeind, U, Beauchamp, M, Beer, D, Beer, R, Belda, F, Bellander, B, Bellier, R, Benali, H, Benard, T, Beqiri, V, Beretta, L, Bernard, F, Bertolini, G, Bilotta, F, Blaabjerg, M, Den Boogert, H, Boutis, K, Bouzat, P, Brooks, B, Brorsson, C, Bullinger, M, Burns, E, Calappi, E, Cameron, P, Carise, E, Castaño león, A, Causin, F, Chevallard, G, Chieregato, A, Christie, B, Cnossen, M, Coles, J, Collett, J, Della Corte, F, Craig, W, Csato, G, Csomos, A, Curry, N, Dahyot fizelier, C, Dawes, H, Dematteo, C, Depreitere, B, Dewey, D, Van Dijck, J, Đilvesi, Đ, Dippel, D, Dizdarevic, K, Donoghue, E, Duek, O, Dulière, G, Dzeko, A, Eapen, G, Emery, C, English, S, Esser, P, Ezer, E, Fabricius, M, Feng, J, Fergusson, D, Figaji, A, Fleming, J, Foks, K, Francony, G, Freedman, S, Freo, U, Frisvold, S, Gagnon, I, Galanaud, D, Gantner, D, Giraud, B, Glocker, B, Golubovic, J, Gómez López, P, Gordon, W, Gradisek, P, Gravel, J, Griesdale, D, Grossi, F, Haagsma, J, Håberg, A, Haitsma, I, Van Hecke, W, Helbok, R, Helseth, E, Van Heugten, C, Hoedemaekers, C, Höfer, S, Horton, L, Hui, J, Huijben, J, Hutchinson, P, Jacobs, B, Van Der Jagt, M, Jankowski, S, Janssens, K, Jelaca, B, Jones, K, Kamnitsas, K, Kaps, R, Karan, M, Katila, A, Kaukonen, K, De Keyser, V, Kivisaari, R, Kolias, A, Kolumbán, B, Kolundžija, K, Kondziella, D, Koskinen, L, Kovács, N, Kramer, A, Kutsogiannis, D, Kyprianou, T, Lagares, A, Lamontagne, F, Latini, R, Lauzier, F, Lazar, I, Ledig, C, Lefering, R, Legrand, V, Levi, L, Lightfoot, R, Lozano, A, Macdonald, S, Major, S, Manara, A, Manhes, P, Maréchal, H, Martino, C, Masala, A, Masson, S, Mattern, J, Mcfadyen, B, Mcmahon, C, Meade, M, Melegh, B, Menovsky, T, Moore, L, Morgado Correia, M, Morganti kossmann, M, Muehlan, H, Mukherjee, P, Murray, L, Van Der Naalt, J, Negru, A, Nelson, D, Nieboer, D, Noirhomme, Q, Nyirádi, J, Oddo, M, Okonkwo, D, Oldenbeuving, A, Ortolano, F, Osmond, M, Payen, J, Perlbarg, V, Persona, P, Pichon, N, Piippo karjalainen, A, Pili floury, S, Pirinen, M, Ple, H, Poca, M, Posti, J, Van Praag, D, Ptito, A, Radoi, A, Ragauskas, A, Raj, R, Real, R, Reed, N, Rhodes, J, Robertson, C, Rocka, S, Røe, C, Røise, O, Roks, G, Rosand, J, Rosenfeld, J, Rosenlund, C, Rosenthal, G, Rossi, S, Rueckert, D, De Ruiter, G, Sacchi, M, Sahakian, B, Sahuquillo, J, Sakowitz, O, Salvato, G, Sánchez porras, R, Sándor, J, Sangha, G, Schäfer, N, Schmidt, S, Schneider, K, Schnyer, D, Schöhl, H, Schoonman, G, Schou, R, Sir, Ö, Skandsen, T, Smeets, D, Sorinola, A, Stamatakis, E, Stevanovic, A, Stevens, R, Sundström, N, Taccone, F, Takala, R, Tanskanen, P, Taylor, M, Telgmann, R, Temkin, N, Teodorani, G, Thomas, M, Tolias, C, Trapani, T, Turgeon, A, Vajkoczy, P, Valadka, A, Valeinis, E, Vallance, S, Vámos, Z, VARGIOLU, ALESSIA, Vega, E, Verheyden, J, Vik, A, Vilcinis, R, Vleggeert lankamp, C, Vogt, L, Volovici, V, Voormolen, D, Vulekovic, P, Vande Vyvere, T, Van Waesberghe, J, Wessels, L, Wildschut, E, Williams, G, Winkler, M, Wolf, S, Wood, G, Xirouchaki, N, Younsi, A, Zaaroor, M, Zelinkova, V, Zemek, R, Zumbo, F, Citerio, G, Vargiolu, A, Zumbo, F., Maas, Andrew I R, Menon, David K, Adelson, P David, Andelic, Nada, Bell, Michael J, Belli, Antonio, Bragge, Peter, Brazinova, Alexandra, Büki, Andrá, Chesnut, Randall M, Citerio, Giuseppe, Coburn, Mark, Cooper, D Jamie, Crowder, A Tamara, Czeiter, Endre, Czosnyka, Marek, Diaz-Arrastia, Ramon, Dreier, Jens P, Duhaime, Ann-Christine, Ercole, Ari, van Essen, Thomas A, Feigin, Valery L, Gao, Guoyi, Giacino, Joseph, Gonzalez-Lara, Laura E, Gruen, Russell L, Gupta, Deepak, Hartings, Jed A, Hill, Sean, Jiang, Ji-yao, Ketharanathan, Naomi, Kompanje, Erwin J O, Lanyon, Linda, Laureys, Steven, Lecky, Fiona, Levin, Harvey, Lingsma, Hester F, Maegele, Marc, Majdan, Marek, Manley, Geoffrey, Marsteller, Jill, Mascia, Luciana, Mcfadyen, Charle, Mondello, Stefania, Newcombe, Virginia, Palotie, Aarno, Parizel, Paul M, Peul, Wilco, Piercy, Jame, Polinder, Suzanne, Puybasset, Loui, Rasmussen, Todd E, Rossaint, Rolf, Smielewski, Peter, Söderberg, Jeannette, Stanworth, Simon J, Stein, Murray B, von Steinbüchel, Nicole, Stewart, William, Steyerberg, Ewout W, Stocchetti, Nino, Synnot, Anneliese, Te Ao, Braden, Tenovuo, Olli, Theadom, Alice, Tibboel, Dick, Videtta, Walter, Wang, Kevin K W, Williams, W Huw, Wilson, Lindsay, Yaffe, Kristine, InTBIR Participants, Investigator, Beretta, Luigi, InTBIR Participants Investigators, Menon, David [0000-0002-3228-9692], Czosnyka, Marek [0000-0003-2446-8006], Ercole, Ari [0000-0001-8350-8093], Newcombe, Virginia [0000-0001-6044-9035], Smielewski, Peter [0000-0001-5096-3938], Apollo - University of Cambridge Repository, Maas A.I.R., Menon D.K., David Adelson P.D., Andelic N., Bell M.J., Belli A., Bragge P., Brazinova A., Buki A., Chesnut R.M., Citerio G., Coburn M., Jamie Cooper D., Tamara Crowder A., Czeiter E., Czosnyka M., Diaz-Arrastia R., Dreier J.P., Duhaime A.-C., Ercole A., van Essen T.A., Feigin V.L., Gao G., Giacino J., Gonzalez-Lara L.E., Gruen R.L., Gupta D., Hartings J.A., Hill S., Jiang J.-Y., Ketharanathan N., Kompanje E.J.O., Lanyon L., Laureys S., Lecky F., Levin H., Lingsma H.F., Maegele M., Majdan M., Manley G., Marsteller J., Mascia L., McFadyen C., Mondello S., Newcombe V., Palotie A., Parizel P.M., Peul W., Piercy J., Polinder S., Puybasset L., Rasmussen T.E., Rossaint R., Smielewski P., Soderberg J., Stanworth S.J., Stein M.B., von Steinbuchel N., Stewart W., Steyerberg E.W., Stocchetti N., Synnot A., Te Ao B., Tenovuo O., Theadom A., Tibboel D., Videtta W., Wang K.K.W., Huw Williams W., Wilson L., Yaffe K., Adams H., Allanson J., Coles J., Hutchinson P.J., Kolias A.G., Sahakian B.J., Stamatakis E., Williams G., Agnoletti V., Martino C., Masala A., Teodorani G., Zumbo F., Amrein K., Ezer E., Kolumban B., Kovacs N., Melegh B., Nyiradi J., Sorinola A., Vamos Z., Andaluz N., Anke A., Frisvold S.K., Antoni A., van As A.B., Figaji A., Audibert G., Azasevac A., Dilvesi D., Golubovic J., Jelaca B., Karan M., Kolundzija K., Negru A., Vulekovic P., Azouvi P., Azzolini M.L., Beretta L., Baciu C., Beqiri V., Chevallard G., Chieregato A., Sacchi M., Badenes R., Belda F.J., Bilotta F., Lozano A., Barlow K.M., Schneider K.J., Bartels R., den Boogert H., Hoedemaekers C., Sir O., Bauerfeind U., Lefering R., Schafer N., Beauchamp M., Gravel J., Beer D., Beer R., Helbok R., Hofer S., Bellander B.-M., Nelson D., Bellier R., Benard T., Carise E., Dahyot-Fizelier C., Giraud B., Benali H., Bernard F., Bertolini G., Masson S., Blaabjerg M., Rosenlund C., Schou R.F., Boutis K., Bouzat P., Francony G., Manhes P., Payen J.-F., Brooks B., Dewey D., Emery C.A., Freedman S., Kramer A., Brorsson C., Koskinen L.-O., Sundstrom N., Bullinger M., Burns E., Calappi E., Ortolano F., Cameron P., Castano-Leon A.M., Gomez Lopez P.A., Lagares A., Causin F., Freo U., Persona P., Rossi S., Christie B., Cnossen M., Dippel D., Foks K., Haagsma J.A., Haitsma I., Huijben J.A., van der Jagt M., Nieboer D., Volovici V., Voormolen D.C., Collett J., Dawes H., Esser P., van Heugten C., Della Corte F., Grossi F., Craig W., Csato G., Csomos A., Curry N., Dematteo C., Meade M., Depreitere B., van Dijck J., de Ruiter G.C.W., Vleggeert-Lankamp C., Dizdarevic K., Donoghue E., Gantner D., Murray L., Trapani T., Vallance S., Duek O., Lazar I., Duliere G.-L., Marechal H., Dzeko A., Eapen G., Jankowski S., English S., Fergusson D., Osmond M., Fabricius M., Kondziella D., Feng J., Hui J., Fleming J., Latini R., Gagnon I., Ptito A., Galanaud D., Glocker B., Kamnitsas K., Ledig C., Rueckert D., Gordon W.A., Gradisek P., Griesdale D., Haberg A.K., van Hecke W., Smeets D., Verheyden J., Vyvere T.V., Helseth E., Roe C., Roise O., Horton L., Jacobs B., van der Naalt J., Janssens K., De Keyser V., Menovsky T., Van Praag D., Jones K.M., Kaps R., Katila A., Posti J., Takala R., Kaukonen K.-M., Kivisaari R., Piippo-Karjalainen A., Raj R., Tanskanen P., Kutsogiannis D., Kyprianou T., Lamontagne F., Lauzier F., Moore L., Turgeon A., Legrand V., Levi L., Zaaroor M., Lightfoot R., Macdonald S., Major S., Vajkoczy P., Wessels L., Winkler M.K.L., Wolf S., Manara A., Thomas M., Mattern J., Sakowitz O., Vogt L., Younsi A., McFadyen B., McMahon C., Correia M.M., Morganti-Kossmann M.C., Rosenfeld J.V., Muehlan H., Schmidt S., Mukherjee P., Noirhomme Q., Oddo M., Okonkwo D.O., Oldenbeuving A.W., Roks G., Schoonman G.G., Perlbarg V., Pichon N., Pili-Floury S., Pirinen M., Ples H., Poca M.A., Radoi A., Sahuquillo J., Ragauskas A., Rocka S., Real R.G.L., Telgmann R., Reed N., Rhodes J., Robertson C., Rosand J., Rosenthal G., Salvato G., Sanchez-Porras R., Sandor J., Sangha G., Schnyer D., Schohl H., Skandsen T., Stevanovic A., van Waesberghe J.V., Stevens R.D., Taccone F.S., Taylor M.S., Zelinkova V., Temkin N., Tolias C.M., Valadka A.B., Valeinis E., Vargiolu A., Vega E., Vik A., Vilcinis R., Wildschut E., Wood G., Xirouchaki N., Zemek R., Maas, A, Menon, D, Adelson, P, Andelic, N, Bell, M, Belli, A, Bragge, P, Brazinova, A, Büki, A, Chesnut, R, Citerio, G, Coburn, M, Cooper, D, Crowder, A, Czeiter, E, Czosnyka, M, Diaz arrastia, R, Dreier, J, Duhaime, A, Ercole, A, Van Essen, T, Feigin, V, Gao, G, Giacino, J, Gonzalez lara, L, Gruen, R, Gupta, D, Hartings, J, Hill, S, Jiang, J, Ketharanathan, N, Kompanje, E, Lanyon, L, Laureys, S, Lecky, F, Levin, H, Lingsma, H, Maegele, M, Majdan, M, Manley, G, Marsteller, J, Mascia, L, Mcfadyen, C, Mondello, S, Newcombe, V, Palotie, A, Parizel, P, Peul, W, Piercy, J, Polinder, S, Puybasset, L, Rasmussen, T, Rossaint, R, Smielewski, P, Söderberg, J, Stanworth, S, Stein, M, Von Steinbüchel, N, Stewart, W, Steyerberg, E, Stocchetti, N, Synnot, A, Te Ao, B, Tenovuo, O, Theadom, A, Tibboel, D, Videtta, W, Wang, K, Williams, W, Wilson, L, Yaffe, K, Adams, H, Agnoletti, V, Allanson, J, Amrein, K, Andaluz, N, Anke, A, Antoni, A, Van As, A, Audibert, G, Azaševac, A, Azouvi, P, Azzolini, M, Baciu, C, Badenes, R, Barlow, K, Bartels, R, Bauerfeind, U, Beauchamp, M, Beer, D, Beer, R, Belda, F, Bellander, B, Bellier, R, Benali, H, Benard, T, Beqiri, V, Beretta, L, Bernard, F, Bertolini, G, Bilotta, F, Blaabjerg, M, Den Boogert, H, Boutis, K, Bouzat, P, Brooks, B, Brorsson, C, Bullinger, M, Burns, E, Calappi, E, Cameron, P, Carise, E, Castaño león, A, Causin, F, Chevallard, G, Chieregato, A, Christie, B, Cnossen, M, Coles, J, Collett, J, Della Corte, F, Craig, W, Csato, G, Csomos, A, Curry, N, Dahyot fizelier, C, Dawes, H, Dematteo, C, Depreitere, B, Dewey, D, Van Dijck, J, Đilvesi, Đ, Dippel, D, Dizdarevic, K, Donoghue, E, Duek, O, Dulière, G, Dzeko, A, Eapen, G, Emery, C, English, S, Esser, P, Ezer, E, Fabricius, M, Feng, J, Fergusson, D, Figaji, A, Fleming, J, Foks, K, Francony, G, Freedman, S, Freo, U, Frisvold, S, Gagnon, I, Galanaud, D, Gantner, D, Giraud, B, Glocker, B, Golubovic, J, Gómez López, P, Gordon, W, Gradisek, P, Gravel, J, Griesdale, D, Grossi, F, Haagsma, J, Håberg, A, Haitsma, I, Van Hecke, W, Helbok, R, Helseth, E, Van Heugten, C, Hoedemaekers, C, Höfer, S, Horton, L, Hui, J, Huijben, J, Hutchinson, P, Jacobs, B, Van Der Jagt, M, Jankowski, S, Janssens, K, Jelaca, B, Jones, K, Kamnitsas, K, Kaps, R, Karan, M, Katila, A, Kaukonen, K, De Keyser, V, Kivisaari, R, Kolias, A, Kolumbán, B, Kolundžija, K, Kondziella, D, Koskinen, L, Kovács, N, Kramer, A, Kutsogiannis, D, Kyprianou, T, Lagares, A, Lamontagne, F, Latini, R, Lauzier, F, Lazar, I, Ledig, C, Lefering, R, Legrand, V, Levi, L, Lightfoot, R, Lozano, A, Macdonald, S, Major, S, Manara, A, Manhes, P, Maréchal, H, Martino, C, Masala, A, Masson, S, Mattern, J, Mcfadyen, B, Mcmahon, C, Meade, M, Melegh, B, Menovsky, T, Moore, L, Morgado Correia, M, Morganti kossmann, M, Muehlan, H, Mukherjee, P, Murray, L, Van Der Naalt, J, Negru, A, Nelson, D, Nieboer, D, Noirhomme, Q, Nyirádi, J, Oddo, M, Okonkwo, D, Oldenbeuving, A, Ortolano, F, Osmond, M, Payen, J, Perlbarg, V, Persona, P, Pichon, N, Piippo karjalainen, A, Pili floury, S, Pirinen, M, Ple, H, Poca, M, Posti, J, Van Praag, D, Ptito, A, Radoi, A, Ragauskas, A, Raj, R, Real, R, Reed, N, Rhodes, J, Robertson, C, Rocka, S, Røe, C, Røise, O, Roks, G, Rosand, J, Rosenfeld, J, Rosenlund, C, Rosenthal, G, Rossi, S, Rueckert, D, De Ruiter, G, Sacchi, M, Sahakian, B, Sahuquillo, J, Sakowitz, O, Salvato, G, Sánchez porras, R, Sándor, J, Sangha, G, Schäfer, N, Schmidt, S, Schneider, K, Schnyer, D, Schöhl, H, Schoonman, G, Schou, R, Sir, Ö, Skandsen, T, Smeets, D, Sorinola, A, Stamatakis, E, Stevanovic, A, Stevens, R, Sundström, N, Taccone, F, Takala, R, Tanskanen, P, Taylor, M, Telgmann, R, Temkin, N, Teodorani, G, Thomas, M, Tolias, C, Trapani, T, Turgeon, A, Vajkoczy, P, Valadka, A, Valeinis, E, Vallance, S, Vámos, Z, Vargiolu, A, Vega, E, Verheyden, J, Vik, A, Vilcinis, R, Vleggeert lankamp, C, Vogt, L, Volovici, V, Voormolen, D, Vulekovic, P, Vande Vyvere, T, Van Waesberghe, J, Wessels, L, Wildschut, E, Williams, G, Winkler, M, Wolf, S, Wood, G, Xirouchaki, N, Younsi, A, Zaaroor, M, Zelinkova, V, Zemek, R, Zumbo, F, Pediatric Surgery, Intensive Care, and Public Health

Subjects
medicine.medical_specialty, EVIDENCE-BASED MEDICINE, Treatment outcome, Poison control, Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0], EMERGENCY-DEPARTMENT VISITS, Review, PLACEBO-CONTROLLED TRIAL, Middle income country, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18], 03 medical and health sciences, 0302 clinical medicine, Intensive care, Brain Injuries, Traumatic, Journal Article, medicine, traumatic barin injury, Humans, 030212 general & internal medicine, Clinical care, Neurologic disease, Psychiatry, DIAGNOSTIC MANAGEMENT STRATEGIES, business.industry, RANDOMIZED CONTROLLED-TRIAL, ACUTE SUBDURAL-HEMATOMA, SEVERE HEAD-INJURY, ROAD TRAFFIC INJURIES, brain injury, Hospital care, 3. Good health, Reconstructive and regenerative medicine Radboud Institute for Health Sciences [Radboudumc 10], Brain Injuries, Health care cost, PATIENT-REPORTED OUTCOMES, Human medicine, Neurology (clinical), business, Humanities, 030217 neurology & neurosurgery, GLASGOW COMA SCALE
Abstract

Executive summary A concerted effort to tackle the global health problem posed by traumatic brain injury (TBI) is long overdue. TBI is a public health challenge of vast, but insufficiently recognised, proportions. Worldwide, more than 50 million people have a TBI each year, and it is estimated that about half the world’s population will have one or more TBIs over their lifetime. TBI is the leading cause of mortality in young adults and a major cause of death and disability across all ages in all countries, with a disproportionate burden of disability and death occurring in low-income and middle-income countries (LMICs). It has been estimated that TBI costs the global economy approximately $US400 billion annually. Deficiencies in prevention, care, and research urgently need to be addressed to reduce the huge burden and societal costs of TBI. This Commission highlights priorities and provides expert recommendations for all stakeholders— policy makers, funders, health-care professionals, researchers, and patient representatives—on clinical and research strategies to reduce this growing public health problem and improve the lives of people with TBI. The epidemiology of TBI is changing: in high-income countries, the number of elderly people with TBI is increasing, mainly due to falls, while in LMICs, the burden of TBI from road traffic incidents is increasing. Data on the frequency of TBI and TBI-related deaths and on the economic impact of brain trauma are often incomplete and vary between countries. Improved, accurate epidemiological monitoring and robust healtheconomic data collection are needed to inform healthcare policy and prevention programmes. Highly developed and coordinated systems of care are crucial for management of patients with TBI. However, in practice, implementation of such frameworks varies greatly and disconnects exist in the chain of care. Optimisation of systems of care should be high on the policy agenda and could yield substantial gains in terms of both patient outcomes and costs to society. TBI is a complex condition, and strong evidence to support treatment guidelines and recommendations is scarce. Most multicentre clinical trials of medical and surgical interventions have failed to show efficacy, despite promising preclinical results. At the bedside, treatment strategies are generally based on guidelines that promote a one-size-fits-all approach and are insufficiently targeted to the needs of individual patients. Attempts to individualise treatment are challenging owing to the diversity of TBI, and are hampered by the use of simplistic methods to characterise its initial type and severity. Advances in genomics, blood biomarkers, magnetic resonance imaging (MRI), and pathophysiological monitoring, combined with informatics to integrate data from multiple sources, offer new research avenues to improve disease characterisation and monitoring of disease evolution. These tools can also aid understanding of disease mechanisms and facilitate targeted treatment strategies for individual patients. Individualised management in the postacute phase and evaluation of the effectiveness of treatment and care processes depend on accurate quantification of outcomes. In practice, however, the use of simplistic methods hinders efforts to quantify outcomes after TBI of all severities. Development and validation of multidimensional approaches will be essential to improve measurement of clinical outcomes, for both research and patient care. In particular, we need to find better ways to characterise the currently under-recognised risk of long-term disabling sequelae in patients with relatively mild injuries. Prognostic models are important to help clinicians to provide reliable information to patients and relatives, and to facilitate comparative audit of care between centres and countries. There is an urgent need for further development, validation, and implementation of prognostic models in TBI, particularly for less severe TBI. This multitude of challenges in TBI—encompassing systems of care, clinical management, and research strategy—demands novel approaches to the generation of new evidence and its implementation in clinical practice. Comparative effectiveness research (CER) offers opportunities to capitalise on the diversity of TBI and systems of care and enables assessment of therapies in real-world conditions; high-quality CER studies can provide strong evidence to support guideline recommendations. The global challenges posed by TBI necessitate global collaborations and a change in research culture to endorse broad data sharing. This Commission covers a range of topics that need to be addressed to confront the global burden of TBI and reduce its effects on individuals and society: epidemiology (section 1); health economics (section 2); prevention (section 3); systems of care (section 4); clinical management (section 5); characterisation of TBI (section 6); outcome assessment (section 7); prognosis (section 8); and new directions for acquiring and implementing evidence (section 9). Table 1 summarises key messages from the Commission and provides recommendations to advance clinical care and research in TBI. We must increase awareness of the scale of the challenge posed by TBI. If we are to tackle the individual and societal burden of TBI, these efforts need to go beyond a clinical and research audience and address the public, politicians, and other stakeholders. We need to develop and implement policies for better prevention and systems of care in order to improve outcomes for individuals with TBI. We also need a commitment to substantial long-term investment in TBI research across a range of disciplines to determine best practice and facilitate individualised management strategies. A combination of innovative research methods and global collaboration, and ways to effectively translate progress in basic and clinical research into clinical practice and public health policy, will be vital for progress in the field.

Published
2017
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