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1. Finnish study of intraoperative irrigation versus drain alone after evacuation of chronic subdural haematoma (FINISH):a study protocol for a multicentre randomised controlled trial

Author

Tommiska, P. (Pihla), Raj, R. (Rahul), Schwartz, C. (Christoph), Kivisaari, R. (Riku), Luostarinen, T. (T.), Satopää, J. (Jarno), Taimela, S. (Simo), Järvinen, T. (Teppo), Ranstam, J. (Jonas), Frantzen, J. (Janek), Posti, J. (Jussi), Luoto, T. M. (Teemu M.), Leinonen, V. (Ville), Tetri, S. (Sami), Koivisto, T. (Timo), Lönnrot, K. (Kimmo), Tommiska, P. (Pihla), Raj, R. (Rahul), Schwartz, C. (Christoph), Kivisaari, R. (Riku), Luostarinen, T. (T.), Satopää, J. (Jarno), Taimela, S. (Simo), Järvinen, T. (Teppo), Ranstam, J. (Jonas), Frantzen, J. (Janek), Posti, J. (Jussi), Luoto, T. M. (Teemu M.), Leinonen, V. (Ville), Tetri, S. (Sami), Koivisto, T. (Timo), and Lönnrot, K. (Kimmo)

Abstract

Introduction: Chronic subdural haematomas (CSDHs) are one of the most common neurosurgical conditions. The goal of surgery is to alleviate symptoms and minimise the risk of symptomatic recurrences. In the past, reoperation rates as high as 20%–30% were described for CSDH recurrences. However, following the introduction of subdural drainage, reoperation rates dropped to approximately 10%. The standard surgical technique includes burr-hole craniostomy, followed by intraoperative irrigation and placement of subdural drainage. Yet, the role of intraoperative irrigation has not been established. If there is no difference in recurrence rates between intraoperative irrigation and no irrigation, CSDH surgery could be carried out faster and more safely by omitting the step of irrigation. The aim of this multicentre randomised controlled trial is to study whether no intraoperative irrigation and subdural drainage results in non-inferior outcome compared with intraoperative irrigation and subdural drainage following burr-hole craniostomy of CSDH. Methods and analysis: This is a prospective, randomised, controlled, parallel group, non-inferiority multicentre trial comparing single burr-hole evacuation of CSDH with intraoperative irrigation and evacuation of CSDH without irrigation. In both groups, a passive subdural drain is used for 48 hours as a standard of treatment. The primary outcome is symptomatic CSDH recurrence requiring reoperation within 6 months. The predefined non-inferiority margin for the primary outcome is 7.5%. To achieve a 2.5% level of significance and 80% power, we will randomise 270 patients per group. Secondary outcomes include modified Rankin Scale, rate of mortality, duration of operation, length of hospital stay, adverse events and change in volume of CSDH. Ethics and dissemination: The study was approved by the institutional review board of the Helsinki and Uusimaa Hospital District (HUS/3035/2019 §238) and duly registered at ClinicalTrials.go

Published
2020

2. Temporal trends in healthcare costs and outcome following ICU admission after traumatic brain injury

Author

Raj, R. (Rahul), Bendel, S. (Stepani), Reinikainen, M. (Matti), Hoppu, S. (Sanna), Luoto, T. (Teemu), Ala-Kokko, T. (Tero), Tetri, S. (Sami), Laitio, R. (Ruut), Koivisto, T. (Timo), Rinne, J. (Jaakko), Kivisaari, R. (Riku), Siironen, J. (Jari), Higgins, A. (Alisa), Skrifvars, M. (Markus), Raj, R. (Rahul), Bendel, S. (Stepani), Reinikainen, M. (Matti), Hoppu, S. (Sanna), Luoto, T. (Teemu), Ala-Kokko, T. (Tero), Tetri, S. (Sami), Laitio, R. (Ruut), Koivisto, T. (Timo), Rinne, J. (Jaakko), Kivisaari, R. (Riku), Siironen, J. (Jari), Higgins, A. (Alisa), and Skrifvars, M. (Markus)

Abstract

Objective: To assess temporal trends in 1-year healthcare costs and outcome of intensive care for traumatic brain injury in Finland. Design: Retrospective observational cohort study. Setting: Multicenter study including four tertiary ICUs. Patients: Three thousand fifty-one adult patients (≥ 18 yr) with significant traumatic brain injury treated in a tertiary ICU during 2003–2013. Intervention: None. Measurements and Main Results: Total 1-year healthcare costs included the index hospitalization costs, rehabilitation unit costs, and social security reimbursements. All costs are reported as 2013 U.S. dollars ($). Outcomes were 1-year mortality and permanent disability. Multivariate regression models, adjusting for case-mix, were used to assess temporal trends in costs and outcome in predefined Glasgow Coma Scale (3–8, 9–12, and 13–15) and age (18–40, 41–64, and ≥65 yr) subgroups. Overall 1-year survival was 76% (n= 2,304), and of 1-year survivors, 37% (n= 850) were permanently disabled. Mean unadjusted 1-year healthcare cost was $39,809 (95% CI, $38,144–$41,473) per patient. Adjusted healthcare costs decreased only in the Glasgow Coma Scale 13–15 and 65 years and older subgroups, due to lower rehabilitation costs. Adjusted 1-year mortality did not change in any subgroup (p < 0.05 for all subgroups). Adjusted risk of permanent disability decreased significantly in all subgroups (p < 0.05). Conclusion: During the last decade, healthcare costs of ICU-admitted traumatic brain injury patients have remained largely the same in Finland. No change in mortality was noted, but the risk for permanent disability decreased significantly. Thus, our results suggest that cost-effectiveness of traumatic brain injury care has improved during the past decade in Finland.

Published
2018

3. 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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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. 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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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