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1. 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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2. 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, 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., 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., and Van Der Naalt J.

Abstract

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
2016

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