Case-mix, care pathways, and outcomes in patients with traumatic brain injury in CENTER-TBI: a European prospective, multicentre, longitudinal, cohort study.
Steyerberg, Ewout W
De Keyser, Véronique
von Steinbüchel, Nicole
Vande Vyvere, Thijs
Maas, Andrew IR
CENTER-TBI Participants and Investigators,
The Lancet. Neurology
The Lancet Publishing Group
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Steyerberg, E. W., Wiegers, E., Sewalt, C., Buki, A., Citerio, G., De Keyser, V., Ercole, A., et al. (2019). Case-mix, care pathways, and outcomes in patients with traumatic brain injury in CENTER-TBI: a European prospective, multicentre, longitudinal, cohort study.. The Lancet. Neurology, 18 (10), 923-934. https://doi.org/10.1016/s1474-4422(19)30232-7
Background Traumatic Brain Injury (TBI) poses a large public health and societal problem, but the contemporary landscape in Europe is poorly defined. We aimed to characterize patient case-mix, care pathways, and outcome of TBI. Methods CENTER-TBI is a Europe-based observational cohort study, consisting of a Core study (Inclusion criteria: clinical diagnosis of TBI, presentation <24 hours post-injury and indication for computed tomography) and a Registry. Patients were differentiated by care pathway: ER stratum (discharged from emergency room), Admission stratum (hospital ward), and ICU stratum (admission to the intensive care unit). Neuro-images and biospecimens were stored in repositories and outcome assessed 6 months post-injury. Findings Data of 4509 patients from 18 countries were analysed in the Core study and 22,782 in the Registry. In the Core study, 848 (19%), 1523 (34%), and 2138 (47%), were in ER, Admission, and ICU strata, respectively. In the ICU stratum, 36% of patients had mild TBI (Glasgow Coma Score 13-15). Compared to the Core cohort, the Registry had more patients in ER (43%) and Admission (38%) strata, with >95% classified as mild TBI. Patients in the Core cohort were older than past studies (median age 50 [IQR: 30-66] years, 28% >65 years), 11% had serious comorbidities, 18% were taking anticoagulant or antiplatelet medication, and alcohol was contributory in 25%. Magnetic resonance imaging (MRI) and blood biomarker measurement enhanced characterisation of injury severity and type. Substantial inter-country differences existed in care pathways and practice. Incomplete recovery (Glasgow Outcome Scale Extended [GOSE] <8) was found in 30%, 53%, and 84% of patients in the ER, Admission and ICU strata respectively. In ICU patients with moderate to severe TBI, the rate of unfavourable outcome (GOSE<5) was 55%, similar to that predicted by the IMPACT prognostic model (O/E ratio 1·06 [95% CI 0·97-1·14]), but mortality was lower than expected (O/E ratio 0·70 [95% CI 0·62-0·76]). Interpretation Patients with TBI currently presenting to European centres are older and often have comorbidities. Overall, most patients present with mild TBI. The incomplete recovery experienced by many motivate precision medicine research and identification of best practices to improve these outcomes.
CENTER-TBI Participants and Investigators, Humans, Prognosis, Patient Admission, Glasgow Coma Scale, Glasgow Outcome Scale, Registries, Cohort Studies, Longitudinal Studies, Prospective Studies, Adult, Aged, Middle Aged, Intensive Care Units, Diagnosis-Related Groups, Critical Pathways, Israel, Europe, Female, Male, Critical Care Outcomes, Brain Injuries, Traumatic
European Union 7th Framework program (EC grant 602150) with additional support from the Hannelore Kohl Stiftung (Germany), from OneMind (USA) and from Integra LifeSciences Corporation (USA).
EC FP7 CP (602150)
External DOI: https://doi.org/10.1016/s1474-4422(19)30232-7
This record's URL: https://www.repository.cam.ac.uk/handle/1810/293231
Attribution-NonCommercial-NoDerivatives 4.0 International
Licence URL: https://creativecommons.org/licenses/by-nc-nd/4.0/