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1. Beware of thermal epiglottis! A case report describing 'teapot syndrome'

Author

Verhees, V. (Veerle), Ketharanathan, N. (Naomi), Oen, I.M.M.H. (Irma), Baartmans, M.G.A. (Martin), Koopman, J.S.H.A. (Joseph), Verhees, V. (Veerle), Ketharanathan, N. (Naomi), Oen, I.M.M.H. (Irma), Baartmans, M.G.A. (Martin), and Koopman, J.S.H.A. (Joseph)

Abstract

Background: The type of scalding injury known as 'teapot syndrome', where hot liquid is grabbed by the child with the aim of ingestion and falls over a child causing burns on the face, upper thorax and arms, is known to cause peri-oral and facial oedema. Thermal epiglottitis following scalds to face, neck and thorax is rare and can occur even in absence of ingestion of a damaging agent or intraoral burns, Awareness of the possibility of thermal epiglottitis, also in scald burns, is imperative to ensure prompt airway protection. Case presentation: We report the case of a child with thermal epiglottitis after a scalding burn from boiling milk resulting in mixed deep burns of the face, neck and chest, but no history of ingestion. Upon presentation there was a progressive stridor and signs of respiratory distress requiring intubation. Laryngoscopy revealed epiglottis oedema, confirming the diagnosis of thermal epiglottitis. Final extubation took place 5 days after initial burn. Conclusions: Thermal epiglottitis following scalds to face, neck and thorax is rare and can occur even in absence of ingestion and intra-oral damage. Burns to the peri-oral area should raise suspicion of additional damage to oral cavity and supraglottic structures, even in absence of intra-oral injury or initial respiratory distress. Awareness of the occurrence of thermal epiglottitis in absence of intra-oral injury is important to diagnose impending upper airway obstruction requiring intubation.

Published
2018
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2. Variation in monitoring and treatment policies for intracranial hypertension in traumatic brain injury: A survey in 66 neurotrauma centers participating in the CENTER-TBI study

Author

Cnossen, M.C. (Maryse), Huijben, J.A. (Jilske A.), van der Jagt, M. (Mathieu), Volovici, V. (Victor), van Essen, T. (Thomas), Polinder, S. (Suzanne), Nelson, D. (David), Ercole, A. (Ari), Stocchetti, N. (Nino), Citerio, G. (Giuseppe), Peul, W.C. (Wilco), Maas, A.I.R. (Andrew), Menon, D.K. (David ), Steyerberg, E.W. (Ewout), Lingsma, H.F. (Hester F.), Adams, H. (Hadie), Alessandro, M. (Masala), Allanson, J.E. (Judith), Amrein, K. (Krisztina), Andaluz, N. (Norberto), Andelic, N. (Nada), Andrea, N. (Nanni), Andreassen, L. (Lasse), Anke, A. (Audny), Antoni, A. (Anna), Ardon, H. (Hilko), Audibert, G. (Gérard), Auslands, K. (Kaspars), Azouvi, P. (Philippe), Baciu, C. (Camelia), Bacon, A. (Andrew), Badenes, R. (Rafael), Baglin, T. (Trevor), Bartels, R.H.M.A. (Ronald), Barzo, P. (P.), Bauerfeind, U. (Ursula), Beer, R. (Ronny), Belda, F.J. (Francisco Javier), Bellander, B.-M. (Bo-Michael), Belli, A. (Antonio), Bellier, R. (Rémy), Benali, H. (Habib), Benard, T. (Thierry), Berardino, M. (Maurizio), Beretta, L. (Luigi), Beynon, C. (Christopher), Bilotta, F. (Federico), Binder, H. (Harald), Biqiri, E. (Erta), Blaabjerg, M. (Morten), Lund, S.B. (Stine Borgen), Bouzat, P. (Pierre), Bragge, P. (Peter), Brazinova, A. (Alexandra), Brehar, F. (Felix), Brorsson, C. (Camilla), Buki, A. (Andras), Bullinger, M. (Monika), Bucková, V. (Veronika), Calappi, E. (Emiliana), Cameron, P. (Peter), Carbayo, L.G. (Lozano Guillermo), Carise, E. (Elsa), Carpenter, K.L.H. (Keri L.H.), Castaño-León, A.M. (Ana M.), Causin, F. (Francesco), Chevallard, G. (Giorgio), Chieregato, A. (Arturo), Cnossen, M. (Maryse), Coburn, M. (Mark), Coles, J.P. (Jonathan P.), Cooper, J.D. (Jamie D.), Correia, M. (Marta), Covic, A. (Amra), Curry, N. (Nicola), Czeiter, E. (Endre), Czosnyka, M. (Marek), Dahyot-Fizelier, C. (Claire), Damas, F. (François), Damas, P. (Pierre), Dawes, H. (Helen), De Keyser, V. (Véronique), Corte, F.D. (Francesco), Depreitere, B. (Bart), Ding, S. (Shenghao), Dippel, D.W.J. (Diederik), Dizdarevic, K. (Kemal), Dulière, G.-L. (Guy-Loup), Dzeko, A. (Adelaida), Eapen, G. (George), Engemann, H. (Heiko), Esser, P. (Patrick), Ezer, E. (Erzsébet), Fabricius, M. (Martin), Feigin, V.L. (V.), Feng, J. (Junfeng), Foks, K. (Kelly), Fossi, F. (Francesca), Francony, G. (Gilles), Frantzén, J. (Janek), Freo, U. (Ulderico), Frisvold, S.K. (Shirin Kordasti), Furmanov, A. (Alex), Gagliardo, P. (Pablo), Galanaud, D. (Damien), Gao, G. (Guoyi), Geleijns, K. (Karin), Ghuysen, A. (Alexandre), Giraud, B. (Benoit), Glocker, B. (Ben), Gomez, P.A. (Pedro A.), Grossi, F. (Francesca), Gruen, R.L. (Russell), Gupta, D. (Deepak), Haagsma, J.A. (Juanita), Hadzic, E. (Ermin), Haitsma, I. (Iain), Hartings, J.A. (Jed), Helbok, R. (Raimund), Helseth, E. (Eirik), Hertle, D. (Daniel), Hill, S. (Sean), Hoedemaekers, A. (Astrid), Hoefer, S. (Stefan), Hutchinson, P.J. (Peter J.), Håberg, K.A. (Kristine Asta), Jacobs, B.C. (Bart), Janciak, I. (Ivan), Janssens, K. (Koen), Jiang, J.-Y. (Ji-Yao), Jones, K. (Kelly), Kalala, J.-P. (Jean-Pierre), Kamnitsas, K. (Konstantinos), Karan, M. (Mladen), Karau, J. (Jana), Katila, A. (Ari), Kaukonen, M. (Maija), Keeling, D. (David), Kerforne, T. (Thomas), Ketharanathan, N. (Naomi), Kettunen, J. (Johannes), Kivisaari, R. (Riku), Kolias, A.G. (Angelos G.), Kolumbán, B. (Bálint), Kompanje, E.J.O. (Erwin), Kondziella, D. (Daniel), Koskinen, L.-O. (Lars-Owe), Kovács, N. (Noémi), Kalovits, F. (Ferenc), Lagares, A. (Alfonso), Lanyon, L. (Linda), Laureys, S. (Steven), Lauritzen, M. (Martin), Lecky, F.E. (Fiona), Ledig, C. (Christian), Lefering, R., Legrand, V. (Valerie), Lei, J. (Jin), Levi, L. (Leon), Lightfoot, R. (Roger), Lingsma, H.F. (Hester), Loeckx, D. (Dirk), Lozano, A. (Angels), Luddington, R. (Roger), Luijten-Arts, C. (Chantal), Maas, A.I.R. (Andrew I.R.), MacDonald, S. (Stephen), MacFayden, C. (Charles), Maegele, M. (Marc), Majdan, M. (Marek), Major, S. (Sebastian), Manara, A. (Alex), Manhes, P. (Pauline), Manley, G. (Geoffrey), Martin, D. (Didier), Martino, C. (Costanza), Maruenda, A. (Armando), Maréchal, H. (Hugues), Mastelova, D. (Dagmara), Mattern, J. (Julia), McMahon, C. (Catherine), Melegh, B. (Béla), Menon, D. (David), Menovsky, T. (Tomas), Morganti-Kossmann, C. (Cristina), Mulazzi, D. (Davide), Mutschler, M. (Manuel), Mühlan, H. (Holger), Negru, A. (Ancuta), Neugebauer, E. (Eddy), Newcombe, V.F. (Virginia F.), Noirhomme, Q. (Quentin), Nyirádi, J. (József), Oddo, M. (Mauro), Oldenbeuving, A.W., Oresic, M. (Matej), Ortolano, F. (Fabrizio), Palotie, A. (Aarno), Parizel, P.M., Patruno, A. (Adriana), Payen, J.-F. (Jean-François), Perera, N. (Natascha), Perlbarg, V. (Vincent), Persona, P. (Paolo), Peul, W. (Wilco), Pichon, N. (Nicolas), Piilgaard, H. (Henning), Piippo, A. (Anna), Floury, S.P. (Sébastien Pili), Pirinen, M. (Matti), Ples, H. (Horia), Pomposo, I. (Inigo), Psota, M. (Marek), Pullens, P. (Pim), Puybasset, L. (Louis), Ragauskas, A. (Arminas), Raj, R. (Rahul), Rambadagalla, M. (Malinka), Rehorcíková, V. (Veronika), Rhodes, J.K.J. (Jonathan K.J.), Richardson, S. (Sylvia), Ripatti, S. (Samuli), Rocka, S. (Saulius), Rodier, N. (Nicolas), Roe, C. (Cecilie), Roise, O. (Olav), Roks, C.M.A.A. (Gerwin), Romegoux, P. (Pauline), Rosand, J. (Jonathan), Rosenfeld, J. (Jeffrey), Rosenlund, C. (Christina), Rosenthal, G. (Guy), Rossaint, R. (Rolf), Rossi, S. (Sandra), Rostalski, T. (Tim), Rueckert, D. (Daniel), de Ruiz, A.F. (Arcaute Felix), Rusnák, M. (Martin), Sacchi, M. (Marco), Sahakian, B. (Barbara), Sahuquillo, J. (Juan), Sakowitz, O. (Oliver), Sala, F. (Francesca), Sanchez-Pena, P. (Paola), Sanchez-Porras, R. (Renan), Sandor, J. (Janos), Santos, E. (Edgar), Sasse, N. (Nadine), Sasu, L. (Luminita), Savo, D. (Davide), Schipper, I.B. (Inger), Schlößer, B. (Barbara), Schmidt, S. (Silke), Schneider, A. (Annette), Schoechl, H. (Herbert), Schoonman, G.G. (Guus), Rico, F.S. (Frederik Schou), Schwendenwein, E. (Elisabeth), Schöll, M. (Michael), Sir, O. (özcan), Skandsen, T. (Toril), Smakman, L. (Lidwien), Smeets, D. (Dominique), Smielewski, P. (Peter), Sorinola, A. (Abayomi), Stamatakis, E. (Emmanuel), Stanworth, S. (Simon), Stegemann, K. (Katrin), Steinbüchel, N. (Nicole), Stevens, R. (Robert), Stewart, W. (William), Sundström, N. (Nina), Synnot, A. (Anneliese), Szabó, J. (József), Söderberg, J. (Jeannette), Taccone, F.S. (Fabio), Tamás, V. (Viktória), Tanskanen, P. (Päivi), Tascu, A. (Alexandru), Taylor, M.S. (Mark Steven), Te, A.B. (Ao Braden), Tenovuo, O. (Olli), Teodorani, G. (Guido), Theadom, A. (Alice), Thomas, M. (Matt), Tibboel, D. (Dick), Tolias, C.M. (Christos M.), Tshibanda, J.-F.L. (Jean-Flory Luaba), Tudora, C.M. (Cristina Maria), Vajkoczy, P. (Peter), Valeinis, E. (Egils), Hecke, W.V. (Wim Van), Praag, D.V. (Dominique Van), Dirk, V.R. (Van Roost), Vlierberghe, E.V. (Eline Van), Vyvere, T.V. (Thijs vande), Vanhaudenhuyse, A. (Audrey), Vargiolu, A. (Alessia), Vega, E. (Emmanuel), Verheyden, J. (Jan), Vespa, P.M. (Paul M.), Vik, A. (Anne), Vilcinis, R. (Rimantas), Vizzino, G. (Giacinta), Vleggeert-Lankamp, C.L.A.M. (Carmen), Vulekovic, P. (Peter), Vámos, Z. (Zoltán), Wade, D. (Derick), Wang, K.K.W. (Kevin K.W.), Wang, L. (Lei), Wildschut, E.D. (Enno), Williams, G. (Guy), Willumsen, L. (Lisette), Wilson, A. (Adam), Wilson, L. (Lindsay), Winkler, M.K.L. (Maren K.L.), Ylén, P. (Peter), Younsi, A. (Alexander), Zaaroor, M. (Menashe), Zhang, Z. (Zhiqun), Zheng, Z. (Zelong), Zumbo, F. (Fabrizio), de Lange, S. (Stefanie), De Ruiter, G.C.W. (Godard C.W.), den Boogert, H. (Hugo), van Dijck, J. (Jeroen), Essen, T.A. (T.) van, van Heugten, C.M. (Caroline M.), Jagt, M. (Mathieu) van der, Naalt, J. (Joukje) van der, Cnossen, M.C. (Maryse), Huijben, J.A. (Jilske A.), van der Jagt, M. (Mathieu), Volovici, V. (Victor), van Essen, T. (Thomas), Polinder, S. (Suzanne), Nelson, D. (David), Ercole, A. (Ari), Stocchetti, N. (Nino), Citerio, G. (Giuseppe), Peul, W.C. (Wilco), Maas, A.I.R. (Andrew), Menon, D.K. (David ), Steyerberg, E.W. (Ewout), Lingsma, H.F. (Hester F.), Adams, H. (Hadie), Alessandro, M. (Masala), Allanson, J.E. (Judith), Amrein, K. (Krisztina), Andaluz, N. (Norberto), Andelic, N. (Nada), Andrea, N. (Nanni), Andreassen, L. (Lasse), Anke, A. (Audny), Antoni, A. (Anna), Ardon, H. (Hilko), Audibert, G. (Gérard), Auslands, K. (Kaspars), Azouvi, P. (Philippe), Baciu, C. (Camelia), Bacon, A. (Andrew), Badenes, R. (Rafael), Baglin, T. (Trevor), Bartels, R.H.M.A. (Ronald), Barzo, P. (P.), Bauerfeind, U. (Ursula), Beer, R. (Ronny), Belda, F.J. (Francisco Javier), Bellander, B.-M. (Bo-Michael), Belli, A. (Antonio), Bellier, R. (Rémy), Benali, H. (Habib), Benard, T. (Thierry), Berardino, M. (Maurizio), Beretta, L. (Luigi), Beynon, C. (Christopher), Bilotta, F. (Federico), Binder, H. (Harald), Biqiri, E. (Erta), Blaabjerg, M. (Morten), Lund, S.B. (Stine Borgen), Bouzat, P. (Pierre), Bragge, P. (Peter), Brazinova, A. (Alexandra), Brehar, F. (Felix), Brorsson, C. (Camilla), Buki, A. (Andras), Bullinger, M. (Monika), Bucková, V. (Veronika), Calappi, E. (Emiliana), Cameron, P. (Peter), Carbayo, L.G. (Lozano Guillermo), Carise, E. (Elsa), Carpenter, K.L.H. (Keri L.H.), Castaño-León, A.M. (Ana M.), Causin, F. (Francesco), Chevallard, G. (Giorgio), Chieregato, A. (Arturo), Cnossen, M. (Maryse), Coburn, M. (Mark), Coles, J.P. (Jonathan P.), Cooper, J.D. (Jamie D.), Correia, M. (Marta), Covic, A. (Amra), Curry, N. (Nicola), Czeiter, E. (Endre), Czosnyka, M. (Marek), Dahyot-Fizelier, C. (Claire), Damas, F. (François), Damas, P. (Pierre), Dawes, H. (Helen), De Keyser, V. (Véronique), Corte, F.D. (Francesco), Depreitere, B. (Bart), Ding, S. (Shenghao), Dippel, D.W.J. (Diederik), Dizdarevic, K. (Kemal), Dulière, G.-L. (Guy-Loup), Dzeko, A. (Adelaida), Eapen, G. (George), Engemann, H. (Heiko), Esser, P. (Patrick), Ezer, E. (Erzsébet), Fabricius, M. (Martin), Feigin, V.L. (V.), Feng, J. (Junfeng), Foks, K. (Kelly), Fossi, F. (Francesca), Francony, G. (Gilles), Frantzén, J. (Janek), Freo, U. (Ulderico), Frisvold, S.K. (Shirin Kordasti), Furmanov, A. (Alex), Gagliardo, P. (Pablo), Galanaud, D. (Damien), Gao, G. (Guoyi), Geleijns, K. (Karin), Ghuysen, A. (Alexandre), Giraud, B. (Benoit), Glocker, B. (Ben), Gomez, P.A. (Pedro A.), Grossi, F. (Francesca), Gruen, R.L. (Russell), Gupta, D. (Deepak), Haagsma, J.A. (Juanita), Hadzic, E. (Ermin), Haitsma, I. (Iain), Hartings, J.A. (Jed), Helbok, R. (Raimund), Helseth, E. (Eirik), Hertle, D. (Daniel), Hill, S. (Sean), Hoedemaekers, A. (Astrid), Hoefer, S. (Stefan), Hutchinson, P.J. (Peter J.), Håberg, K.A. (Kristine Asta), Jacobs, B.C. (Bart), Janciak, I. (Ivan), Janssens, K. (Koen), Jiang, J.-Y. (Ji-Yao), Jones, K. (Kelly), Kalala, J.-P. (Jean-Pierre), Kamnitsas, K. (Konstantinos), Karan, M. (Mladen), Karau, J. (Jana), Katila, A. (Ari), Kaukonen, M. (Maija), Keeling, D. (David), Kerforne, T. (Thomas), Ketharanathan, N. (Naomi), Kettunen, J. (Johannes), Kivisaari, R. (Riku), Kolias, A.G. (Angelos G.), Kolumbán, B. (Bálint), Kompanje, E.J.O. (Erwin), Kondziella, D. (Daniel), Koskinen, L.-O. (Lars-Owe), Kovács, N. (Noémi), Kalovits, F. (Ferenc), Lagares, A. (Alfonso), Lanyon, L. (Linda), Laureys, S. (Steven), Lauritzen, M. (Martin), Lecky, F.E. (Fiona), Ledig, C. (Christian), Lefering, R., Legrand, V. (Valerie), Lei, J. (Jin), Levi, L. (Leon), Lightfoot, R. (Roger), Lingsma, H.F. (Hester), Loeckx, D. (Dirk), Lozano, A. (Angels), Luddington, R. (Roger), Luijten-Arts, C. (Chantal), Maas, A.I.R. (Andrew I.R.), MacDonald, S. (Stephen), MacFayden, C. (Charles), Maegele, M. (Marc), Majdan, M. (Marek), Major, S. (Sebastian), Manara, A. (Alex), Manhes, P. (Pauline), Manley, G. (Geoffrey), Martin, D. (Didier), Martino, C. (Costanza), Maruenda, A. (Armando), Maréchal, H. (Hugues), Mastelova, D. (Dagmara), Mattern, J. (Julia), McMahon, C. (Catherine), Melegh, B. (Béla), Menon, D. (David), Menovsky, T. (Tomas), Morganti-Kossmann, C. (Cristina), Mulazzi, D. (Davide), Mutschler, M. (Manuel), Mühlan, H. (Holger), Negru, A. (Ancuta), Neugebauer, E. (Eddy), Newcombe, V.F. (Virginia F.), Noirhomme, Q. (Quentin), Nyirádi, J. (József), Oddo, M. (Mauro), Oldenbeuving, A.W., Oresic, M. (Matej), Ortolano, F. (Fabrizio), Palotie, A. (Aarno), Parizel, P.M., Patruno, A. (Adriana), Payen, J.-F. (Jean-François), Perera, N. (Natascha), Perlbarg, V. (Vincent), Persona, P. (Paolo), Peul, W. (Wilco), Pichon, N. (Nicolas), Piilgaard, H. (Henning), Piippo, A. (Anna), Floury, S.P. (Sébastien Pili), Pirinen, M. (Matti), Ples, H. (Horia), Pomposo, I. (Inigo), Psota, M. (Marek), Pullens, P. (Pim), Puybasset, L. (Louis), Ragauskas, A. (Arminas), Raj, R. (Rahul), Rambadagalla, M. (Malinka), Rehorcíková, V. (Veronika), Rhodes, J.K.J. (Jonathan K.J.), Richardson, S. (Sylvia), Ripatti, S. (Samuli), Rocka, S. (Saulius), Rodier, N. (Nicolas), Roe, C. (Cecilie), Roise, O. (Olav), Roks, C.M.A.A. (Gerwin), Romegoux, P. (Pauline), Rosand, J. (Jonathan), Rosenfeld, J. (Jeffrey), Rosenlund, C. (Christina), Rosenthal, G. (Guy), Rossaint, R. (Rolf), Rossi, S. (Sandra), Rostalski, T. (Tim), Rueckert, D. (Daniel), de Ruiz, A.F. (Arcaute Felix), Rusnák, M. (Martin), Sacchi, M. (Marco), Sahakian, B. (Barbara), Sahuquillo, J. (Juan), Sakowitz, O. (Oliver), Sala, F. (Francesca), Sanchez-Pena, P. (Paola), Sanchez-Porras, R. (Renan), Sandor, J. (Janos), Santos, E. (Edgar), Sasse, N. (Nadine), Sasu, L. (Luminita), Savo, D. (Davide), Schipper, I.B. (Inger), Schlößer, B. (Barbara), Schmidt, S. (Silke), Schneider, A. (Annette), Schoechl, H. (Herbert), Schoonman, G.G. (Guus), Rico, F.S. (Frederik Schou), Schwendenwein, E. (Elisabeth), Schöll, M. (Michael), Sir, O. (özcan), Skandsen, T. (Toril), Smakman, L. (Lidwien), Smeets, D. (Dominique), Smielewski, P. (Peter), Sorinola, A. (Abayomi), Stamatakis, E. (Emmanuel), Stanworth, S. (Simon), Stegemann, K. (Katrin), Steinbüchel, N. (Nicole), Stevens, R. (Robert), Stewart, W. (William), Sundström, N. (Nina), Synnot, A. (Anneliese), Szabó, J. (József), Söderberg, J. (Jeannette), Taccone, F.S. (Fabio), Tamás, V. (Viktória), Tanskanen, P. (Päivi), Tascu, A. (Alexandru), Taylor, M.S. (Mark Steven), Te, A.B. (Ao Braden), Tenovuo, O. (Olli), Teodorani, G. (Guido), Theadom, A. (Alice), Thomas, M. (Matt), Tibboel, D. (Dick), Tolias, C.M. (Christos M.), Tshibanda, J.-F.L. (Jean-Flory Luaba), Tudora, C.M. (Cristina Maria), Vajkoczy, P. (Peter), Valeinis, E. (Egils), Hecke, W.V. (Wim Van), Praag, D.V. (Dominique Van), Dirk, V.R. (Van Roost), Vlierberghe, E.V. (Eline Van), Vyvere, T.V. (Thijs vande), Vanhaudenhuyse, A. (Audrey), Vargiolu, A. (Alessia), Vega, E. (Emmanuel), Verheyden, J. (Jan), Vespa, P.M. (Paul M.), Vik, A. (Anne), Vilcinis, R. (Rimantas), Vizzino, G. (Giacinta), Vleggeert-Lankamp, C.L.A.M. (Carmen), Vulekovic, P. (Peter), Vámos, Z. (Zoltán), Wade, D. (Derick), Wang, K.K.W. (Kevin K.W.), Wang, L. (Lei), Wildschut, E.D. (Enno), Williams, G. (Guy), Willumsen, L. (Lisette), Wilson, A. (Adam), Wilson, L. (Lindsay), Winkler, M.K.L. (Maren K.L.), Ylén, P. (Peter), Younsi, A. (Alexander), Zaaroor, M. (Menashe), Zhang, Z. (Zhiqun), Zheng, Z. (Zelong), Zumbo, F. (Fabrizio), de Lange, S. (Stefanie), De Ruiter, G.C.W. (Godard C.W.), den Boogert, H. (Hugo), van Dijck, J. (Jeroen), Essen, T.A. (T.) van, van Heugten, C.M. (Caroline M.), Jagt, M. (Mathieu) van der, and Naalt, J. (Joukje) van der

Abstract

Background: No definitive evidence exists on how intracranial hypertension should be treated in patients with traumatic brain injury (TBI). It is therefore likely that centers and practitioners individually balance potential benefits and risks of different intracranial pressure (ICP) management strategies, resulting in practice variation. The aim of this study was to examine variation in monitoring and treatment policies for intracranial hypertension in patients with TBI. Methods: A 29-item survey on ICP monitoring and treatment was developed on the basis of literature and expert opinion, and it was pilot-tested in 16 centers. The questionnaire was sent to 68 neurotrauma centers participating in the Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. Results: The survey was completed by 66 centers (97% response rate). Centers were mainly academic hospitals (n=60, 91%) and designated level I trauma centers (n=44, 67%). The Brain Trauma Foundation guidelines were used in 49 (74%) centers. Approximately 90% of the participants (n=58) indicated placing an ICP monitor in patients with severe TBI and computed tomographic abnormalities. There was no consensus on other indications or on peri-insertion precautions. We found wide variation in the use of first- and second-tier treatments for elevated ICP. Approximately half of the centers were classified as using a relatively aggressive approach to ICP monitoring and treatment (n=32, 48%), whereas the others were considered more conservative (n=34, 52%). Conclusions: Substantial variation was found regarding monitoring and treatment policies in patients with TBI and intracranial hypertension. The results of this survey indicate a lack of consensus between European neurotrauma centers and provide an opportunity and necessity for comparative effectiveness research.

Published
2017
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3. A review of blood transfusions in a trauma unit for young children

Author

Salverda, M., Ketharanathan, N. (Naomi), Dijk, M. (Monique) van, Beltchev, E., Buys, H., Numanoglu, A. (Alp), As, A.B. (Àrjan Bastiaan) van, Salverda, M., Ketharanathan, N. (Naomi), Dijk, M. (Monique) van, Beltchev, E., Buys, H., Numanoglu, A. (Alp), and As, A.B. (Àrjan Bastiaan) van

Abstract

Background. Trauma is the leading cause of mortality and morbidity worldwide. Blood transfusions play an incremental role in the acute phase, yet practice varies owing to variations in transfusion thresholds and concerns about potential complications, especially in children. Objectives. To evaluate protocol adherence to blood transfusion thresholds in paediatric trauma patients and determine the degree of blood product wastage, as defined by discarded units. Methods. A retrospective, descriptive study of trauma patients (age 0 - 13 years) who received a blood transfusion in the trauma unit at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa, over a 5.5-year period (1 January 2009 - 1 July 2014). Haemoglobin (Hb) transfusion thresholds were defined as 10 g/dL for neurotrauma patients and patients requiring skin grafting or a musculocutaneous flap (group 1). All other trauma patients had an Hb transfusion threshold of 7 g/dL (group 2). Results. A total of 144 patients were included (mean age 5.2 years (standard deviation (SD) 3.3), 68.1% male). The mean Hb increase after transfusion was 3.5 g/dL (SD 1.7). Adherence to the transfusion Hb threshold protocol was 96.7% for group 1 v. 34.0% for group 2. No complications were reported. Average blood wastage was 3.5 units per year during the study period. Conclusions. Adherence to paediatric blood transfusion protocol was low in the Hb threshold group <7 g/dL. However, transfusion-related complications and wastage were minimal. Further prospective research is required to determine optimal blood transfusion guidelines for paediatric trauma patients.

Published
2017
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4. 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. (Maryse), Polinder, S. (Suzanne), Lingsma, H.F. (Hester F.), Maas, A.I.R. (Andrew), Menon, D.K. (David ), Steyerberg, E.W. (Ewout), Adams, H. (Hadie), Alessandro, M. (Masala), Allanson, J.E. (Judith), Amrein, K. (Krisztina), Andaluz, N. (Norberto), Andelic, N. (Nada), Andrea, N. (Nanni), Andreassen, L. (Lasse), Anke, A. (Audny), Antoni, A. (Anna), Ardon, H. (Hilko), Audibert, G. (Gérard), Auslands, K. (Kaspars), Azouvi, P. (Philippe), Baciu, C. (Camelia), Bacon, A. (Andrew), Badenes, R. (Rafael), Baglin, T. (Trevor), Bartels, R. (Ronald), Barzó, P. (Pál), Bauerfeind, U. (Ursula), Beer, R. (Ronny), Belda, F.J. (Francisco Javier), Bellander, B.-M. (Bo-Michael), Belli, A. (Antonio), Bellier, R. (Rémy), Benali, H. (Habib), Benard, T. (Thierry), Berardino, M. (Maurizio), Beretta, L. (Luigi), Beynon, C. (Christopher), Bilotta, F. (Federico), Binder, H. (Harald), Biqiri, E. (Erta), Blaabjerg, M. (Morten), Borgen, L.S. (Lund Stine), Bouzat, P. (Pierre), Bragge, P. (Peter), Brazinova, A. (Alexandra), Brehar, F. (Felix), Brorsson, C. (Camilla), Buki, A. (Andras), Bullinger, M. (Monika), Bučková, V. (Veronika), Calappi, E. (Emiliana), Cameron, P. (Peter), Carbayo, L.G. (Lozano Guillermo), Carise, E. (Elsa), Carpenter, C., Castaño-León, A.M. (Ana M.), Causin, F. (Francesco), Chevallard, G. (Giorgio), Chieregato, A. (Arturo), Citerio, G. (Giuseppe), Coburn, M. (Mark), Coles, J.P. (Jonathan P.), Cooper, J.D. (Jamie D.), Correia, M. (Marta), Covic, A. (Amra), Curry, N. (Nicola), Czeiter, E. (Endre), Czosnyka, M. (Marek), Dahyot-Fizelier, C. (Claire), Damas, F. (François), Damas, P. (Pierre), Dawes, H. (Helen), De Keyser, V. (Véronique), Della Corte, F. (Francesco), Depreitere, B. (Bart), Ding, S. (Shenghao), Dippel, D.W.J. (Diederik), Dizdarevic, K. (Kemal), Dulière, G.-L. (Guy-Loup), Dzeko, A. (Adelaida), Eapen, G. (George), Engemann, H. (Heiko), Ercole, A. (Ari), Esser, P. (Patrick), Ezer, E. (Erzsébet), Fabricius, M. (Martin), Feigin, V.L. (V.), Feng, J. (Junfeng), Foks, K. (Kelly), Fossi, F. (Francesca), Francony, G. (Gilles), Frantzén, J. (Janek), Freo, U. (Ulderico), Frisvold, S.K. (Shirin Kordasti), Furmanov, A. (Alex), Gagliardo, P. (Pablo), Galanaud, D. (Damien), Gao, G. (Guoyi), Geleijns, K. (Karin), Ghuysen, A. (Alexandre), Giraud, B. (Benoit), Glocker, B. (Ben), Gomez, P.A. (Pedro A.), Grossi, F. (Francesca), Gruen, R.L. (Russell), Gupta, D. (Deepak), Haagsma, J.A. (Juanita), Hadzic, E. (Ermin), Haitsma, I. (Iain), Hartings, J.A. (Jed), Helbok, R. (Raimund), Helseth, E. (Eirik), Hertle, D. (Daniel), Hill, S. (Sean), Hoedemaekers, A. (Astrid), Hoefer, S. (Stefan), Hutchinson, P.J. (Peter J.), Håberg, A.K. (Asta Kristine), Jacobs, B.C. (Bart), Janciak, I. (Ivan), Janssens, K. (Koen), Jiang, J.-Y. (Ji-Yao), Jones, K. (Kelly), Kalala, J.-P. (Jean-Pierre), Kamnitsas, K. (Konstantinos), Karan, M. (Mladen), Karau, J. (Jana), Katila, A. (Ari), Kaukonen, M. (Maija), Keeling, D. (David), Kerforne, T. (Thomas), Ketharanathan, N. (Naomi), Kettunen, J. (Johannes), Kivisaari, R. (Riku), Kolias, A.G. (Angelos G.), Kolumbán, B. (Bálint), Kompanje, E.J.O. (Erwin), Kondziella, D. (Daniel), Koskinen, L.-O. (Lars-Owe), Kovács, N. (Noémi), Kalovits, F. (Ferenc), Lagares, A. (Alfonso), Lanyon, L. (Linda), Laureys, S. (Steven), Lauritzen, M. (Martin), Lecky, F.E. (Fiona), Ledig, C. (Christian), Lefering, R., Legrand, V. (Valerie), Lei, J. (Jin), Levi, L. (Leon), Lightfoot, R. (Roger), Lingsma, H.F. (Hester), Loeckx, D. (Dirk), Lozano, A. (Angels), Luddington, R. (Roger), Luijten-Arts, C. (Chantal), MacDonald, S. (Stephen), MacFayden, C. (Charles), Maegele, M. (Marc), Majdan, M. (Marek), Major, S. (Sebastian), Manara, A. (Alex), Manhes, P. (Pauline), Manley, G. (Geoffrey), Martin, D. (Didier), Martino, C. (Costanza), Maruenda, A. (Armando), Maréchal, H. (Hugues), Mastelova, D. (Dagmara), Mattern, J. (Julia), McMahon, C. (Catherine), Melegh, B. (Béla), Menovsky, T. (Tomas), Morganti-Kossmann, C. (Cristina), Mulazzi, D. (Davide), Mutschler, M. (Manuel), Mühlan, H. (Holger), Negru, A. (Ancuta), Nelson, D. (David), Neugebauer, E. (Eddy), Newcombe, V.F. (Virginia F.), Noirhomme, Q. (Quentin), Nyirádi, J. (József), Oddo, M. (Mauro), Oldenbeuving, A. (Annemarie), Oresic, M. (Matej), Ortolano, F. (Fabrizio), Palotie, A. (Aarno), Parizel, P.M., Patruno, A. (Adriana), Payen, J.-F. (Jean-François), Perera, N. (Natascha), Perlbarg, V. (Vincent), Persona, P. (Paolo), Peul, W.C. (Wilco), Pichon, N. (Nicolas), Piilgaard, H. (Henning), Piippo, A. (Anna), Pili, F.S. (Floury Sébastien), Pirinen, M. (Matti), Ples, H. (Horia), Pomposo, I. (Inigo), Psota, M. (Marek), Pullens, P. (Pim), Puybasset, L. (Louis), Ragauskas, A. (Arminas), Raj, R. (Rahul), Rambadagalla, M. (Malinka), Rehorčíková, V. (Veronika), Rhodes, J.K.J. (Jonathan K.J.), Richardson, S. (Sylvia), Ripatti, S. (Samuli), Rocka, S. (Saulius), Rodier, N. (Nicolas), Roe, C. (Cecilie), Roise, O. (Olav), Roks, G. (Gerwin), Romegoux, P. (Pauline), Rosand, J. (Jonathan), Rosenfeld, J. (Jeffrey), Rosenlund, C. (Christina), Rosenthal, G. (Guy), Rossaint, R. (Rolf), Rossi, S. (Sandra), Rostalski, T. (Tim), Rueckert, D.L. (Danie L.), Ruiz De Arcaute, F. (Felix), Rusnák, M. (Martin), Sacchi, M. (Marco), Sahakian, B. (Barbara), Sahuquillo, J. (Juan), Sakowitz, O. (Oliver), Sala, F. (Francesca), Sanchez-Pena, P. (Paola), Sanchez-Porras, R. (Renan), Sandor, J. (Janos), Santos, E. (Edgar), Sasse, N. (Nadine), Sasu, L. (Luminita), Savo, D. (Davide), Schipper, I.B. (Inger), Schlößer, B. (Barbara), Schmidt, S. (Silke), Schneider, A. (Annette), Schoechl, H. (Herbert), Schoonman, G.G. (Guus), Schou, R. (Rico), Schwendenwein, E. (Elisabeth), Schöll, M. (Michael), Sir, O. (Özcan), Skandsen, T. (Toril), Smakman, L. (Lidwien), Smeets, D. (Dirk), Smielewski, P. (Peter), Sorinola, A. (Abayomi), Stamatakis, E.L. (Emmanue L.), Stanworth, S. (Simon), Stegemann, K. (Katrin), Steinbüchel, N. (Nicole), Stevens, R. (Robert), Stewart, W. (William), Stocchetti, N. (Nino), Sundström, N. (Nina), Synnot, A. (Anneliese), Szabó, J. (József), Söderberg, J. (Jeannette), Taccone, F.S. (Fabio), Tamás, V. (Viktória), Tanskanen, P. (Päivi), Tascu, A. (Alexandru), Taylor, M.S. (Mark Steven), Te Ao, B. (Braden), Tenovuo, O. (Olli), Teodorani, G. (Guido), Theadom, A. (Alice), Thomas, M. (Matt), Tibboel, D. (Dick), Tolias, C.M. (Christos M.), Tshibanda, J.-F.L. (Jean-Flory Luaba), Tudora, C.M. (Cristina Maria), Vajkoczy, P. (Peter), Valeinis, E. (Egils), Hecke, W. (Wim) van, Van Praag, D. (Dominique), Van Roost, D. (Dirk), Van Vlierberghe, E. (Eline), Vande Vyvere, T. (Thijs), Vanhaudenhuyse, A. (Audrey), Vargiolu, A. (Alessia), Vega, E. (Emmanuel), Verheyden, J. (Jan), Vespa, P.M. (Paul M.), Vik, A. (Anne), Vilcinis, R. (Rimantas), Vizzino, G. (Giacinta), Vleggeert-Lankamp, C.L.A.M. (Carmen), Volovici, V. (Victor), Vulekovic, P. (Peter), Vámos, Z. (Zoltán), Wade, D. (Derick), Wang, K.K.W. (Kevin K.W.), Wang, L. (Lei), Wildschut, E. (Eno), Williams, G. (Guy), Willumsen, L. (Lisette), Wilson, A. (Adam), Wilson, L. (Lindsay), Winkler, M.K.L. (Maren K. L.), Ylén, P. (Peter), Younsi, A. (Alexander), Zaaroor, M. (Menashe), Zhang, Z. (Zhiqun), Zheng, Z. (Zelong), Zumbo, F. (Fabrizio), De Lange, S. (Stefanie), De Ruiter, G.C.W. (Godard C.W.), Den Boogert, H. (Hugo), Van Dijck, J. (Jeroen), Essen, T.A. (T.) van, van Heugten, C.M. (Caroline M.), Jagt, M. (Mathieu) van der, Naalt, J. (Joukje) van der, Cnossen, M.C. (Maryse), Polinder, S. (Suzanne), Lingsma, H.F. (Hester F.), Maas, A.I.R. (Andrew), Menon, D.K. (David ), Steyerberg, E.W. (Ewout), Adams, H. (Hadie), Alessandro, M. (Masala), Allanson, J.E. (Judith), Amrein, K. (Krisztina), Andaluz, N. (Norberto), Andelic, N. (Nada), Andrea, N. (Nanni), Andreassen, L. (Lasse), Anke, A. (Audny), Antoni, A. (Anna), Ardon, H. (Hilko), Audibert, G. (Gérard), Auslands, K. (Kaspars), Azouvi, P. (Philippe), Baciu, C. (Camelia), Bacon, A. (Andrew), Badenes, R. (Rafael), Baglin, T. (Trevor), Bartels, R. (Ronald), Barzó, P. (Pál), Bauerfeind, U. (Ursula), Beer, R. (Ronny), Belda, F.J. (Francisco Javier), Bellander, B.-M. (Bo-Michael), Belli, A. (Antonio), Bellier, R. (Rémy), Benali, H. (Habib), Benard, T. (Thierry), Berardino, M. (Maurizio), Beretta, L. (Luigi), Beynon, C. (Christopher), Bilotta, F. (Federico), Binder, H. (Harald), Biqiri, E. (Erta), Blaabjerg, M. (Morten), Borgen, L.S. (Lund Stine), Bouzat, P. (Pierre), Bragge, P. (Peter), Brazinova, A. (Alexandra), Brehar, F. (Felix), Brorsson, C. (Camilla), Buki, A. (Andras), Bullinger, M. (Monika), Bučková, V. (Veronika), Calappi, E. (Emiliana), Cameron, P. (Peter), Carbayo, L.G. (Lozano Guillermo), Carise, E. (Elsa), Carpenter, C., Castaño-León, A.M. (Ana M.), Causin, F. (Francesco), Chevallard, G. (Giorgio), Chieregato, A. (Arturo), Citerio, G. (Giuseppe), Coburn, M. (Mark), Coles, J.P. (Jonathan P.), Cooper, J.D. (Jamie D.), Correia, M. (Marta), Covic, A. (Amra), Curry, N. (Nicola), Czeiter, E. (Endre), Czosnyka, M. (Marek), Dahyot-Fizelier, C. (Claire), Damas, F. (François), Damas, P. (Pierre), Dawes, H. (Helen), De Keyser, V. (Véronique), Della Corte, F. (Francesco), Depreitere, B. (Bart), Ding, S. (Shenghao), Dippel, D.W.J. (Diederik), Dizdarevic, K. (Kemal), Dulière, G.-L. (Guy-Loup), Dzeko, A. (Adelaida), Eapen, G. (George), Engemann, H. (Heiko), Ercole, A. (Ari), Esser, P. (Patrick), Ezer, E. (Erzsébet), Fabricius, M. (Martin), Feigin, V.L. (V.), Feng, J. (Junfeng), Foks, K. (Kelly), Fossi, F. (Francesca), Francony, G. (Gilles), Frantzén, J. (Janek), Freo, U. (Ulderico), Frisvold, S.K. (Shirin Kordasti), Furmanov, A. (Alex), Gagliardo, P. (Pablo), Galanaud, D. (Damien), Gao, G. (Guoyi), Geleijns, K. (Karin), Ghuysen, A. (Alexandre), Giraud, B. (Benoit), Glocker, B. (Ben), Gomez, P.A. (Pedro A.), Grossi, F. (Francesca), Gruen, R.L. (Russell), Gupta, D. (Deepak), Haagsma, J.A. (Juanita), Hadzic, E. (Ermin), Haitsma, I. (Iain), Hartings, J.A. (Jed), Helbok, R. (Raimund), Helseth, E. (Eirik), Hertle, D. (Daniel), Hill, S. (Sean), Hoedemaekers, A. (Astrid), Hoefer, S. (Stefan), Hutchinson, P.J. (Peter J.), Håberg, A.K. (Asta Kristine), Jacobs, B.C. (Bart), Janciak, I. (Ivan), Janssens, K. (Koen), Jiang, J.-Y. (Ji-Yao), Jones, K. (Kelly), Kalala, J.-P. (Jean-Pierre), Kamnitsas, K. (Konstantinos), Karan, M. (Mladen), Karau, J. (Jana), Katila, A. (Ari), Kaukonen, M. (Maija), Keeling, D. (David), Kerforne, T. (Thomas), Ketharanathan, N. (Naomi), Kettunen, J. (Johannes), Kivisaari, R. (Riku), Kolias, A.G. (Angelos G.), Kolumbán, B. (Bálint), Kompanje, E.J.O. (Erwin), Kondziella, D. (Daniel), Koskinen, L.-O. (Lars-Owe), Kovács, N. (Noémi), Kalovits, F. (Ferenc), Lagares, A. (Alfonso), Lanyon, L. (Linda), Laureys, S. (Steven), Lauritzen, M. (Martin), Lecky, F.E. (Fiona), Ledig, C. (Christian), Lefering, R., Legrand, V. (Valerie), Lei, J. (Jin), Levi, L. (Leon), Lightfoot, R. (Roger), Lingsma, H.F. (Hester), Loeckx, D. (Dirk), Lozano, A. (Angels), Luddington, R. (Roger), Luijten-Arts, C. (Chantal), MacDonald, S. (Stephen), MacFayden, C. (Charles), Maegele, M. (Marc), Majdan, M. (Marek), Major, S. (Sebastian), Manara, A. (Alex), Manhes, P. (Pauline), Manley, G. (Geoffrey), Martin, D. (Didier), Martino, C. (Costanza), Maruenda, A. (Armando), Maréchal, H. (Hugues), Mastelova, D. (Dagmara), Mattern, J. (Julia), McMahon, C. (Catherine), Melegh, B. (Béla), Menovsky, T. (Tomas), Morganti-Kossmann, C. (Cristina), Mulazzi, D. (Davide), Mutschler, M. (Manuel), Mühlan, H. (Holger), Negru, A. (Ancuta), Nelson, D. (David), Neugebauer, E. (Eddy), Newcombe, V.F. (Virginia F.), Noirhomme, Q. (Quentin), Nyirádi, J. (József), Oddo, M. (Mauro), Oldenbeuving, A. (Annemarie), Oresic, M. (Matej), Ortolano, F. (Fabrizio), Palotie, A. (Aarno), Parizel, P.M., Patruno, A. (Adriana), Payen, J.-F. (Jean-François), Perera, N. (Natascha), Perlbarg, V. (Vincent), Persona, P. (Paolo), Peul, W.C. (Wilco), Pichon, N. (Nicolas), Piilgaard, H. (Henning), Piippo, A. (Anna), Pili, F.S. (Floury Sébastien), Pirinen, M. (Matti), Ples, H. (Horia), Pomposo, I. (Inigo), Psota, M. (Marek), Pullens, P. (Pim), Puybasset, L. (Louis), Ragauskas, A. (Arminas), Raj, R. (Rahul), Rambadagalla, M. (Malinka), Rehorčíková, V. (Veronika), Rhodes, J.K.J. (Jonathan K.J.), Richardson, S. (Sylvia), Ripatti, S. (Samuli), Rocka, S. (Saulius), Rodier, N. (Nicolas), Roe, C. (Cecilie), Roise, O. (Olav), Roks, G. (Gerwin), Romegoux, P. (Pauline), Rosand, J. (Jonathan), Rosenfeld, J. (Jeffrey), Rosenlund, C. (Christina), Rosenthal, G. (Guy), Rossaint, R. (Rolf), Rossi, S. (Sandra), Rostalski, T. (Tim), Rueckert, D.L. (Danie L.), Ruiz De Arcaute, F. (Felix), Rusnák, M. (Martin), Sacchi, M. (Marco), Sahakian, B. (Barbara), Sahuquillo, J. (Juan), Sakowitz, O. (Oliver), Sala, F. (Francesca), Sanchez-Pena, P. (Paola), Sanchez-Porras, R. (Renan), Sandor, J. (Janos), Santos, E. (Edgar), Sasse, N. (Nadine), Sasu, L. (Luminita), Savo, D. (Davide), Schipper, I.B. (Inger), Schlößer, B. (Barbara), Schmidt, S. (Silke), Schneider, A. (Annette), Schoechl, H. (Herbert), Schoonman, G.G. (Guus), Schou, R. (Rico), Schwendenwein, E. (Elisabeth), Schöll, M. (Michael), Sir, O. (Özcan), Skandsen, T. (Toril), Smakman, L. (Lidwien), Smeets, D. (Dirk), Smielewski, P. (Peter), Sorinola, A. (Abayomi), Stamatakis, E.L. (Emmanue L.), Stanworth, S. (Simon), Stegemann, K. (Katrin), Steinbüchel, N. (Nicole), Stevens, R. (Robert), Stewart, W. (William), Stocchetti, N. (Nino), Sundström, N. (Nina), Synnot, A. (Anneliese), Szabó, J. (József), Söderberg, J. (Jeannette), Taccone, F.S. (Fabio), Tamás, V. (Viktória), Tanskanen, P. (Päivi), Tascu, A. (Alexandru), Taylor, M.S. (Mark Steven), Te Ao, B. (Braden), Tenovuo, O. (Olli), Teodorani, G. (Guido), Theadom, A. (Alice), Thomas, M. (Matt), Tibboel, D. (Dick), Tolias, C.M. (Christos M.), Tshibanda, J.-F.L. (Jean-Flory Luaba), Tudora, C.M. (Cristina Maria), Vajkoczy, P. (Peter), Valeinis, E. (Egils), Hecke, W. (Wim) van, Van Praag, D. (Dominique), Van Roost, D. (Dirk), Van Vlierberghe, E. (Eline), Vande Vyvere, T. (Thijs), Vanhaudenhuyse, A. (Audrey), Vargiolu, A. (Alessia), Vega, E. (Emmanuel), Verheyden, J. (Jan), Vespa, P.M. (Paul M.), Vik, A. (Anne), Vilcinis, R. (Rimantas), Vizzino, G. (Giacinta), Vleggeert-Lankamp, C.L.A.M. (Carmen), Volovici, V. (Victor), Vulekovic, P. (Peter), Vámos, Z. (Zoltán), Wade, D. (Derick), Wang, K.K.W. (Kevin K.W.), Wang, L. (Lei), Wildschut, E. (Eno), Williams, G. (Guy), Willumsen, L. (Lisette), Wilson, A. (Adam), Wilson, L. (Lindsay), Winkler, M.K.L. (Maren K. L.), Ylén, P. (Peter), Younsi, A. (Alexander), Zaaroor, M. (Menashe), Zhang, Z. (Zhiqun), Zheng, Z. (Zelong), Zumbo, F. (Fabrizio), De Lange, S. (Stefanie), De Ruiter, G.C.W. (Godard C.W.), Den Boogert, H. (Hugo), Van Dijck, J. (Jeroen), Essen, T.A. (T.) van, van Heugten, C.M. (Caroline M.), Jagt, M. (Mathieu) van der, and Naalt, J. (Joukje) van der

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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5. Collaborative European neurotrauma effectiveness research in traumatic brain injury (CENTER-TBI): A prospective longitudinal observational study

Author

Maas, A.I.R. (Andrew), Menon, D.K. (David ), Steyerberg, E.W. (Ewout), Citerio, G. (Giuseppe), Lecky, F.E. (Fiona), Manley, G. (Geoffrey), Hill, S. (Sean), Legrand, V. (Valerie), Sorgner, A. (Annina), Andelic, N. (Nada), Andreassen, L. (Lasse), Andrews, P.J.D. (Peter), Audibert, G. (Gérard), Audny, A. (Anke), Azouv, P. (Philippe), Barzo, P. (P.), Beer, R. (Ronny), Bellander, B.-M. (Bo-Michael), Belli, A. (Antonio), Benali, H. (Habib), Berardino, M. (Maurizio), Beretta, L. (Luigi), Brazinova, A. (Alexandra), Binder, H. (Harald), Brehar, F. (Felix), Buki, A. (Andras), Bullinger, M. (Monika), Cakmak, E. (Ela), Callebaut, I. (Ina), Cameron, P. (Peter), Lozano, G.C. (Guillermo Carbayo), Carpenter, K.L.H. (Keri L.H.), Chieregato, A. (Arturo), Coburn, M. (Mark), Coles, J.P. (Jonathan P.), Cooper, J. (Jamie), Cnossen, M.C. (Maryse), Curry, N. (Nicola), Czeiter, E. (Endre), Czosnyka, M. (Marek), Dahyot-Fitzelier, C. (Claire), Damas, F. (François), Dawes, H. (Helen), De Keyser, V. (Véronique), De Luca, A. (Alessandra), De Ruiter, G.C.W. (Godard C.W.), De Witte, O. (Olivier), Corte, F.D. (Francesco), Demeter, B. (Béla), Depreitere, B. (Bart), Dippel, D.W.J. (Diederik), Dizdarevic, K. (Kemal), Dreier, J.P. (Jens), Eapen, G. (George), Ercole, A. (Ari), Esser, P. (Patrick), Fabricius, M. (Martin), Feremans, L. (Len), Feigin, V.L. (V.), Fossi, F. (Francesca), Forsyth, F. (Faye), Florian, S. (Stefan), Frisvold, S.K. (Shirin Kordasti), Frosini, C. (Caterina), Furmanov, A. (Alex), Frantzén, J. (Janek), Gadda, D. (Davide), Gagliardo, P. (Pablo), Galanaud, D. (Damien), Gao, G. (Guoyi), Ghuysen, A. (Alexandre), Godbolt, A. (Alison), Gonšorová, V. (Veronika), Grigore, Z. (Zapulih), Gruen, R.L. (Russell), Haagsma, J.A. (Juanita), Hallaert, G. (Giorgio), Hadzic, E. (Ermin), Haitsma, I. (Iain), Hartings, J.A. (Jed), Helbok, R. (Raimund), Helseth, E. (Eirik), Hoefer, S. (Stefan), Holling, M. (Markus), Hunfeld, M. (Maayke), Hutchinson, P.J. (Peter J.), Illéš, R. (Robert), Janssens, K. (Koen), Bovend'Eerdt, T.J.H. (Thamar J.H.), Jiang, J.-Y. (Ji-Yao), Jones, K.M. (Kelly M.), Kalala, J.-P. (Jean-Pierre), Kalovits, F. (Ferenc), Kasprian, G. (Gregor), Katila, A. (Ari), Ketharanathan, N. (Naomi), Kolias, A.G. (Angelos G.), Kolibay, F. (Felix), Kondziella, D. (Daniel), Koskinen, L.-O. (Lars-Owe), Lagares, A. (Alfonso), Lanyon, L. (Linda), Laureys, S. (Steven), Lefering, R., Levi, L. (Leon), Lightfoot, R. (Roger), Lingsma, H.F. (Hester), Loeckx, D. (Dirk), Lohkamp, L.-N. (Laura-Nanna), Lötjönen, J. (Jyrki), Lumenta, C. (Christianto), Lyttle, M.D. (Mark), Maegele, M. (Marc), Majdan, M. (Marek), Manara, A. (Alex), Maréchal, H. (Hugues), Martino, C. (Costanza), Mascia, L. (Luciana), Mauritz, W. (Walter), McMahon, C. (Catherine), Menovsky, T. (Tomas), Mitchell, P. (Patrick), Mladenov, N. (Nikolay), Morganti-Kossmann, C. (Cristina), Nelson, D. (David), Neugebauer, E. (Eddy), Newcombe, V.F. (Virginia F.), Oddo, M. (Mauro), Oresic, M. (Matej), Orzalesi, V. (Vanni), Outtrim, J.G. (Joanne G.), Palotie, A. (Aarno), Parizel, P.M., Payen, J.-F. (Jean-François), Perlbarg, V. (Vincent), Peul, W.C. (Wilco), Pichon, N. (Nicolas), Piippo, A. (Anna), Floury, S.P. (Sébastien Pili), Ples, H. (Horia), Polinder, S. (Suzanne), Preiksaitis, A. (Aidanas), Psota, M. (Marek), Pullens, P. (Pim), Puybasset, L. (Louis), Ragauskas, A. (Arminas), Raj, R. (Rahul), Reiner, M. (Michael), Rhodes, J.K.J. (Jonathan K.J.), Richardson, S. (Sylvia), Ripatti, S. (Samuli), Rocka, S. (Saulius), Roosenfeld, J. (Jeffrey), Rosand, J. (Jonathan), Rosenlund, C. (Christina), Rosenthal, G. (Guy), Rossaint, R. (Rolf), Rossi, S. (Sandra), Rueckert, D. (Daniel), Rusnák, M. (Martin), Rynkowski, M.A. (Michal A.), Sahuquillo, J. (Juan), Sakowitz, O. (Oliver), Sandor, J. (Janos), Schmidt, S. (Silke), Schoechl, H. (Herbert), Schou, R. (Rico), Skandsen, T. (Toril), Sonne, M. (Morten), Schwendenwein, E. (Elisabeth), Smeets, D. (Dirk), Smieleweski, P. (Peter), Söderberg, J. (Jeannette), Stamatakis, E. (Emmanuel), Stanworth, S. (Simon), Stefini, R. (Roberto), Stevens, R. (Robert), Stewart, W. (William), Stocchetti, N. (Nino), Stummer, W. (Walter), Szabó, J. (József), Tascu, A. (Alexandru), Tenovuo, O. (Olli), Theadom, A. (Alice), Tibboel, D. (Dick), Tolias, C.M. (Christos M.), Unterberg, A. (Andreas), Vajkoczy, P. (Peter), Vargiolu, A. (Alessia), Naalt, J. (Joukje) van der, Essen, T.A. (T.) van, Hecke, W. (Wim) van, Van Praag, D. (Dominique), Van Roost, D. (Dirk), Vandenbulcke, T. (Tim), Vande Hauwe, L. (Luc), Jagt, M. (Mathieu) van der, Vega, E. (Emmanuel), Verheyden, J. (Jan), Verma, V. (Vishwajit), Vespa, P.M. (Paul M.), Vik, A. (Anne), Vilcinis, R. (Rimantas), Von Steinbüchel, N. (Nicole), Vulekovic, P. (Peter), Wang, K.K.W. (Kevin), Wildschut, E. (Eno), Williams, G. (Guy), Wilson, M. (Mark), Wilson, L. (Lindsay), Wolf, S. (Stefan), Ylén, P. (Peter), Zaaroor, M. (Menashe), Zolfaghari, P. (Parjam), Martin, D. (Didier), D'Orio, V. (Vincenzo), Damas, P. (Pierre), Luaba Tshibanda, J.-F. (Jean-Flory), Maas, A.I.R. (Andrew), Menon, D.K. (David ), Steyerberg, E.W. (Ewout), Citerio, G. (Giuseppe), Lecky, F.E. (Fiona), Manley, G. (Geoffrey), Hill, S. (Sean), Legrand, V. (Valerie), Sorgner, A. (Annina), Andelic, N. (Nada), Andreassen, L. (Lasse), Andrews, P.J.D. (Peter), Audibert, G. (Gérard), Audny, A. (Anke), Azouv, P. (Philippe), Barzo, P. (P.), Beer, R. (Ronny), Bellander, B.-M. (Bo-Michael), Belli, A. (Antonio), Benali, H. (Habib), Berardino, M. (Maurizio), Beretta, L. (Luigi), Brazinova, A. (Alexandra), Binder, H. (Harald), Brehar, F. (Felix), Buki, A. (Andras), Bullinger, M. (Monika), Cakmak, E. (Ela), Callebaut, I. (Ina), Cameron, P. (Peter), Lozano, G.C. (Guillermo Carbayo), Carpenter, K.L.H. (Keri L.H.), Chieregato, A. (Arturo), Coburn, M. (Mark), Coles, J.P. (Jonathan P.), Cooper, J. (Jamie), Cnossen, M.C. (Maryse), Curry, N. (Nicola), Czeiter, E. (Endre), Czosnyka, M. (Marek), Dahyot-Fitzelier, C. (Claire), Damas, F. (François), Dawes, H. (Helen), De Keyser, V. (Véronique), De Luca, A. (Alessandra), De Ruiter, G.C.W. (Godard C.W.), De Witte, O. (Olivier), Corte, F.D. (Francesco), Demeter, B. (Béla), Depreitere, B. (Bart), Dippel, D.W.J. (Diederik), Dizdarevic, K. (Kemal), Dreier, J.P. (Jens), Eapen, G. (George), Ercole, A. (Ari), Esser, P. (Patrick), Fabricius, M. (Martin), Feremans, L. (Len), Feigin, V.L. (V.), Fossi, F. (Francesca), Forsyth, F. (Faye), Florian, S. (Stefan), Frisvold, S.K. (Shirin Kordasti), Frosini, C. (Caterina), Furmanov, A. (Alex), Frantzén, J. (Janek), Gadda, D. (Davide), Gagliardo, P. (Pablo), Galanaud, D. (Damien), Gao, G. (Guoyi), Ghuysen, A. (Alexandre), Godbolt, A. (Alison), Gonšorová, V. (Veronika), Grigore, Z. (Zapulih), Gruen, R.L. (Russell), Haagsma, J.A. (Juanita), Hallaert, G. (Giorgio), Hadzic, E. (Ermin), Haitsma, I. (Iain), Hartings, J.A. (Jed), Helbok, R. (Raimund), Helseth, E. (Eirik), Hoefer, S. (Stefan), Holling, M. (Markus), Hunfeld, M. (Maayke), Hutchinson, P.J. (Peter J.), Illéš, R. (Robert), Janssens, K. (Koen), Bovend'Eerdt, T.J.H. (Thamar J.H.), Jiang, J.-Y. (Ji-Yao), Jones, K.M. (Kelly M.), Kalala, J.-P. (Jean-Pierre), Kalovits, F. (Ferenc), Kasprian, G. (Gregor), Katila, A. (Ari), Ketharanathan, N. (Naomi), Kolias, A.G. (Angelos G.), Kolibay, F. (Felix), Kondziella, D. (Daniel), Koskinen, L.-O. (Lars-Owe), Lagares, A. (Alfonso), Lanyon, L. (Linda), Laureys, S. (Steven), Lefering, R., Levi, L. (Leon), Lightfoot, R. (Roger), Lingsma, H.F. (Hester), Loeckx, D. (Dirk), Lohkamp, L.-N. (Laura-Nanna), Lötjönen, J. (Jyrki), Lumenta, C. (Christianto), Lyttle, M.D. (Mark), Maegele, M. (Marc), Majdan, M. (Marek), Manara, A. (Alex), Maréchal, H. (Hugues), Martino, C. (Costanza), Mascia, L. (Luciana), Mauritz, W. (Walter), McMahon, C. (Catherine), Menovsky, T. (Tomas), Mitchell, P. (Patrick), Mladenov, N. (Nikolay), Morganti-Kossmann, C. (Cristina), Nelson, D. (David), Neugebauer, E. (Eddy), Newcombe, V.F. (Virginia F.), Oddo, M. (Mauro), Oresic, M. (Matej), Orzalesi, V. (Vanni), Outtrim, J.G. (Joanne G.), Palotie, A. (Aarno), Parizel, P.M., Payen, J.-F. (Jean-François), Perlbarg, V. (Vincent), Peul, W.C. (Wilco), Pichon, N. (Nicolas), Piippo, A. (Anna), Floury, S.P. (Sébastien Pili), Ples, H. (Horia), Polinder, S. (Suzanne), Preiksaitis, A. (Aidanas), Psota, M. (Marek), Pullens, P. (Pim), Puybasset, L. (Louis), Ragauskas, A. (Arminas), Raj, R. (Rahul), Reiner, M. (Michael), Rhodes, J.K.J. (Jonathan K.J.), Richardson, S. (Sylvia), Ripatti, S. (Samuli), Rocka, S. (Saulius), Roosenfeld, J. (Jeffrey), Rosand, J. (Jonathan), Rosenlund, C. (Christina), Rosenthal, G. (Guy), Rossaint, R. (Rolf), Rossi, S. (Sandra), Rueckert, D. (Daniel), Rusnák, M. (Martin), Rynkowski, M.A. (Michal A.), Sahuquillo, J. (Juan), Sakowitz, O. (Oliver), Sandor, J. (Janos), Schmidt, S. (Silke), Schoechl, H. (Herbert), Schou, R. (Rico), Skandsen, T. (Toril), Sonne, M. (Morten), Schwendenwein, E. (Elisabeth), Smeets, D. (Dirk), Smieleweski, P. (Peter), Söderberg, J. (Jeannette), Stamatakis, E. (Emmanuel), Stanworth, S. (Simon), Stefini, R. (Roberto), Stevens, R. (Robert), Stewart, W. (William), Stocchetti, N. (Nino), Stummer, W. (Walter), Szabó, J. (József), Tascu, A. (Alexandru), Tenovuo, O. (Olli), Theadom, A. (Alice), Tibboel, D. (Dick), Tolias, C.M. (Christos M.), Unterberg, A. (Andreas), Vajkoczy, P. (Peter), Vargiolu, A. (Alessia), Naalt, J. (Joukje) van der, Essen, T.A. (T.) van, Hecke, W. (Wim) van, Van Praag, D. (Dominique), Van Roost, D. (Dirk), Vandenbulcke, T. (Tim), Vande Hauwe, L. (Luc), Jagt, M. (Mathieu) van der, Vega, E. (Emmanuel), Verheyden, J. (Jan), Verma, V. (Vishwajit), Vespa, P.M. (Paul M.), Vik, A. (Anne), Vilcinis, R. (Rimantas), Von Steinbüchel, N. (Nicole), Vulekovic, P. (Peter), Wang, K.K.W. (Kevin), Wildschut, E. (Eno), Williams, G. (Guy), Wilson, M. (Mark), Wilson, L. (Lindsay), Wolf, S. (Stefan), Ylén, P. (Peter), Zaaroor, M. (Menashe), Zolfaghari, P. (Parjam), Martin, D. (Didier), D'Orio, V. (Vincenzo), Damas, P. (Pierre), and Luaba Tshibanda, J.-F. (Jean-Flory)

Abstract

BACKGROUND: Current classification of traumatic brain injury (TBI) is suboptimal, and management is based on weak evidence, with little attempt to personalize treatment. A need exists for new precision medicine and stratified management approaches that incorporate emerging technologies. OBJECTIVE: To improve characterization and classification of TBI and to identify best clinical care, using comparative effectiveness research approaches. METHODS: This multicenter, longitudinal, prospective, observational study in 22 countries across Europe and Israel will collect detailed data from 5400 consenting patients, presenting within 24 hours of injury, with a clinical diagnosis of TBI and an indication for computed tomography. Broader registry-level data collection in approximately 20 000 patients will assess generalizability. Cross sectional comprehensive outcome assessments, including quality of life and neuropsychological testing, will be performed at 6 months. Longitudinal assessments will continue up to 24 months post TBI in patient subsets. Advanced neuroimaging and genomic and biomarker data will be used to improve characterization, and analyses will include neuroinformatics approaches to address variations in process and clinical care. Results will be integrated with living systematic reviews in a process of knowledge transfer. The study initiation was from October to December 2014, and the recruitment period was for 18 to 24 months. EXPECTED OUTCOMES: Collaborative European NeuroTrauma Effectiveness Research in TBI should provide novel multidimensional approaches to TBI characterization and classification, evidence to support treatment recommendations, and benchmarks for quality of care. Data and sample repositories will ensure opportunities for legacy research. DISCUSSION: Comparative effectiveness research provides an alternative to reductionistic clinical trials in restricted patient populations by exploiting differences in biology, care, and outcome to support

Published
2015
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