Changing care pathways and between-center practice variations in intensive care for traumatic brain injury across Europe [Elektronisk resurs] a CENTER-TBI analysis
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Huijben, Jilske A (författare)
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Wiegers, Eveline J A (författare)
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Lingsma, Hester F (författare)
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Citerio, Giuseppe (författare)
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Maas, Andrew I R (författare)
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Menon, David K (författare)
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Ercole, Ari (författare)
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Nelson, David (författare)
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van der Jagt, Mathieu (författare)
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Steyerberg, Ewout W (författare)
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Helbok, Raimund (författare)
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Lecky, Fiona (författare)
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Peul, Wilco (författare)
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Birg, Tatiana (författare)
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Zoerle, Tommaso (författare)
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Carbonara, Marco (författare)
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Stocchetti, Nino (författare)
- Publicerad: 2020
- Engelska.
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Ingår i: Intensive Care Medicine. - 0342-4642. ; 46:5, 995-1004
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- Relaterad länk:
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http://www.umu.se/ (Värdpublikation)
Sammanfattning
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- PURPOSE: To describe ICU stay, selected management aspects, and outcome of Intensive Care Unit (ICU) patients with traumatic brain injury (TBI) in Europe, and to quantify variation across centers. METHODS: This is a prospective observational multicenter study conducted across 18 countries in Europe and Israel. Admission characteristics, clinical data, and outcome were described at patient- and center levels. Between-center variation in the total ICU population was quantified with the median odds ratio (MOR), with correction for case-mix and random variation between centers. RESULTS: A total of 2138 patients were admitted to the ICU, with median age of 49 years; 36% of which were mild TBI (Glasgow Coma Scale; GCS 13-15). Within, 72 h 636 (30%) were discharged and 128 (6%) died. Early deaths and long-stay patients (> 72 h) had more severe injuries based on the GCS and neuroimaging characteristics, compared with short-stay patients. Long-stay patients received more monitoring and were treated at higher intensity, and experienced worse 6-month outcome compared to short-stay patients. Between-center variations were prominent in the proportion of short-stay patients (MOR = 2.3, p < 0.001), use of intracranial pressure (ICP) monitoring (MOR = 2.5, p < 0.001) and aggressive treatments (MOR = 2.9, p < 0.001); and smaller in 6-month outcome (MOR = 1.2, p = 0.01). CONCLUSIONS: Half of contemporary TBI patients at the ICU have mild to moderate head injury. Substantial between-center variations exist in ICU stay and treatment policies, and less so in outcome. It remains unclear whether admission of short-stay patients represents appropriate prudence or inappropriate use of clinical resources.
Ämnesord
- Medical and Health Sciences (hsv)
- Clinical Medicine (hsv)
- Neurology (hsv)
- Medicin och hälsovetenskap (hsv)
- Klinisk medicin (hsv)
- Neurologi (hsv)
Genre
- government publication (marcgt)
Indexterm och SAB-rubrik
- Intensive care unit
- Intracranial pressure
- Outcome
- Traumatic brain injury
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Intensive Care Medicine