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3. Clinical outcomes and end-of-life treatment in 596 patients with isolated traumatic brain injury:a retrospective comparison of two Dutch level-I trauma centers

Author

Niemeyer, Menco J.S., Jochems, Denise, Van Ditshuizen, Jan C., de Kanter, Janneke, Cremers, Lotte, van Hattem, Martijn, Den Hartog, Dennis, Houwert, Roderick Marijn, Leenen, Luke P.H., van Wessem, Karlijn J.P., Niemeyer, Menco J.S., Jochems, Denise, Van Ditshuizen, Jan C., de Kanter, Janneke, Cremers, Lotte, van Hattem, Martijn, Den Hartog, Dennis, Houwert, Roderick Marijn, Leenen, Luke P.H., and van Wessem, Karlijn J.P.

Abstract

Purpose: With an increasingly older population and rise in incidence of traumatic brain injury (TBI), end-of-life decisions have become frequent. This study investigated the rate of withdrawal of life sustaining treatment (WLST) and compared treatment outcomes in patients with isolated TBI in two Dutch level-I trauma centers. Methods: From 2011 to 2016, a retrospective cohort study of patients aged ≥ 18 years with isolated moderate-to-severe TBI (Abbreviated Injury Scale (AIS) head ≥ 3) was conducted at the University Medical Center Rotterdam (UMC-R) and the University Medical Center Utrecht (UMC-U). Demographics, radiologic injury characteristics, clinical outcomes, and functional outcomes at 3–6 months post-discharge were collected. Results: The study population included 596 patients (UMC-R: n = 326; UMC-U: n = 270). There were no statistical differences in age, gender, mechanism of injury, and radiologic parameters between both institutes. UMC-R patients had a higher AIShead (UMC-R: 5 [4–5] vs. UMC-U: 4 [4–5], p < 0.001). There was no difference in the prehospital Glasgow Coma Scale (GCS). However, UMC-R patients had lower GCSs in the Emergency Department and used more prehospital sedation. Total in-hospital mortality was 29% (n = 170), of which 71% (n = 123) occurred after WLST. Two percent (n = 10) remained in unresponsive wakefulness syndrome (UWS) state during follow-up. Discussion: This study demonstrated a high WLST rate among deceased patients with isolated TBI. Demographics and outcomes were similar for both centers even though AIShead was significantly higher in UMC-R patients. Possibly, prehospital sedation might have influenced AIS coding. Few patients persisted in UWS. Further research is needed on WLST patients in a broader spectrum of ethics, culture, and complex medical profiles, as it is a growing practice in modern critical care. Level of evidence: Level III, retrospective cohort study.

Published
2024

9. TWO-YEAR MORTALITY AND END-OF-LIFE DECISIONS AFTER TRAUMATIC SPINAL CORD INJURY: DATA FROM A LEVEL 1 TRAUMA CENTRE IN THE NETHERLANDS

Author

Zorgeenheid Traumatologie, Medische Staf Intensive Care, Other research (not in main researchprogram), Infection & Immunity, Revalidatiegeneeskunde Onderzoek, Brain, Niemeyer, Menco J.S., Peuker, Felix, Sadiqi, Said, Kerckhoffs, Monika C., Houwert, R. Marijn, Van Wessem, Karlijn J.P., Post, Marcel W.M., Stolwijk, Janneke M., Zorgeenheid Traumatologie, Medische Staf Intensive Care, Other research (not in main researchprogram), Infection & Immunity, Revalidatiegeneeskunde Onderzoek, Brain, Niemeyer, Menco J.S., Peuker, Felix, Sadiqi, Said, Kerckhoffs, Monika C., Houwert, R. Marijn, Van Wessem, Karlijn J.P., Post, Marcel W.M., and Stolwijk, Janneke M.

Published
2023

10. Outcome of severely injured patients in a unique trauma system with 24/7 double trauma surgeon on-call service

Author

Zorgeenheid Traumatologie, Infection & Immunity, Other research (not in main researchprogram), DHS-Medisch, van Wessem, Karlijn J.P., Leenen, Luke P.H., Houwert, R. Marijn, Benders, Kim E.M., Simmermacher, Roger K.J., van Baal, Mark C.P.M., de Bruin, Ivar G.J.M., de Jong, Mirjam B., Nijs, Stefaan J.B., Hietbrink, Falco, Zorgeenheid Traumatologie, Infection & Immunity, Other research (not in main researchprogram), DHS-Medisch, van Wessem, Karlijn J.P., Leenen, Luke P.H., Houwert, R. Marijn, Benders, Kim E.M., Simmermacher, Roger K.J., van Baal, Mark C.P.M., de Bruin, Ivar G.J.M., de Jong, Mirjam B., Nijs, Stefaan J.B., and Hietbrink, Falco

Published
2023

15. Incidence, causes and consequences of moderate and severe traumatic brain injury as determined by Abbreviated Injury Score in the Netherlands

Author

Jochems, Denise, van Rein, Eveline, Niemeijer, Menco, van Heijl, Mark, van Es, Michael A., Nijboer, Tanja, Leenen, Luke P, Houwert, R. Marijn, van Wessem, Karlijn J.P., Jochems, Denise, van Rein, Eveline, Niemeijer, Menco, van Heijl, Mark, van Es, Michael A., Nijboer, Tanja, Leenen, Luke P, Houwert, R. Marijn, and van Wessem, Karlijn J.P.

Abstract

Traumatic brain injury (TBI) is a leading cause of death and disability. Epidemiology seems to be changing. TBIs are increasingly caused by falls amongst elderly, whilst we see less polytrauma due to road traffic accidents (RTA). Data on epidemiology is essential to target prevention strategies. A nationwide retrospective cohort study was conducted. The Dutch National Trauma Database was used to identify all patients over 17 years old who were admitted to a hospital with moderate and severe TBI (AIS ≥ 3) in the Netherlands from January 2015 until December 2017. Subgroup analyses were done for the elderly and polytrauma patients. 12,295 patients were included in this study. The incidence of moderate and severe TBI was 30/100.000 person-years, 13% of whom died. Median age was 65 years and falls were the most common trauma mechanism, followed by RTAs. Amongst elderly, RTAs consisted mostly of bicycle accidents. Mortality rates were higher for elderly (18%) and polytrauma patients (24%). In this national database more elderly patients who most often sustained the injury due to a fall or an RTA were seen. Bicycle accidents were very frequent, suggesting prevention could be an important aspect in order to decrease morbidity and mortality.

Published
2021

16. Incidence, causes and consequences of moderate and severe traumatic brain injury as determined by Abbreviated Injury Score in the Netherlands

Author

Leerstoel Postma, Helmholtz Institute, Experimental Psychology (onderzoeksprogramma PF), Jochems, Denise, van Rein, Eveline, Niemeijer, Menco, van Heijl, Mark, van Es, Michael A., Nijboer, Tanja, Leenen, Luke P, Houwert, R. Marijn, van Wessem, Karlijn J.P., Leerstoel Postma, Helmholtz Institute, Experimental Psychology (onderzoeksprogramma PF), Jochems, Denise, van Rein, Eveline, Niemeijer, Menco, van Heijl, Mark, van Es, Michael A., Nijboer, Tanja, Leenen, Luke P, Houwert, R. Marijn, and van Wessem, Karlijn J.P.

Published
2021

17. Epidemiology of paediatric moderate and severe traumatic brain injury in the Netherlands.

Author

Leerstoel Postma, Helmholtz Institute, Experimental Psychology (onderzoeksprogramma PF), Jochems, Denise, van Rein, Eveline, Niemeijer, Menco, van Heijl, M., van Es, Michael A., Nijboer, Tanja, Leenen, L.P.H., Houwert, R.M., van Wessem, Karlijn J.P., Leerstoel Postma, Helmholtz Institute, Experimental Psychology (onderzoeksprogramma PF), Jochems, Denise, van Rein, Eveline, Niemeijer, Menco, van Heijl, M., van Es, Michael A., Nijboer, Tanja, Leenen, L.P.H., Houwert, R.M., and van Wessem, Karlijn J.P.

Published
2021

18. Incidence, causes and consequences of moderate and severe traumatic brain injury as determined by Abbreviated Injury Score in the Netherlands

Author

Verpleegafd Vaatchirurgie D4 Oost, Zorgeenheid Traumatologie, MS Oogheelkunde, Regionaal Traumanetwerk, Neurologen, Brain, Revalidatiegeneeskunde Onderzoek, Infection & Immunity, Other research (not in main researchprogram), Jochems, Denise, van Rein, Eveline, Niemeijer, Menco, van Heijl, Mark, van Es, Michael A., Nijboer, Tanja, Leenen, Luke P.H., Houwert, R. Marijn, van Wessem, Karlijn J.P., Verpleegafd Vaatchirurgie D4 Oost, Zorgeenheid Traumatologie, MS Oogheelkunde, Regionaal Traumanetwerk, Neurologen, Brain, Revalidatiegeneeskunde Onderzoek, Infection & Immunity, Other research (not in main researchprogram), Jochems, Denise, van Rein, Eveline, Niemeijer, Menco, van Heijl, Mark, van Es, Michael A., Nijboer, Tanja, Leenen, Luke P.H., Houwert, R. Marijn, and van Wessem, Karlijn J.P.

Published
2021

22. Current treatment and outcomes of traumatic sternovertebral fractures: a systematic review

Author

Zorgeenheid Traumatologie, MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Infection & Immunity, Klei, Dorine S., Öner, F. Cumhur, Leenen, Luke P.H., van Wessem, Karlijn J.P., Zorgeenheid Traumatologie, MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Infection & Immunity, Klei, Dorine S., Öner, F. Cumhur, Leenen, Luke P.H., and van Wessem, Karlijn J.P.

Published
2021

23. No Need for Sternal Fixation in Traumatic Sternovertebral Fractures: Outcomes of a 10-Year Retrospective Cohort Study

Author

Zorgeenheid Traumatologie, MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Infection & Immunity, Klei, Dorine S., Öner, F. Cumhur, Leenen, Luke P.H., van Wessem, Karlijn J.P., Zorgeenheid Traumatologie, MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Infection & Immunity, Klei, Dorine S., Öner, F. Cumhur, Leenen, Luke P.H., and van Wessem, Karlijn J.P.

Published
2021

24. Persistent inflammation, immunosuppression and catabolism syndrome (PICS) after polytrauma: A rare syndrome with major consequences

Author

Zorgeenheid Traumatologie, Experimentele Afdeling Longziekten, Other research (not in main researchprogram), CDL Arcadia, Infection & Immunity, Hesselink, Lillian, Hoepelman, Ruben J., Spijkerman, Roy, de Groot, Mark C.H., van Wessem, Karlijn J.P., Koenderman, Leo, Leenen, Luke P.H., Hietbrink, Falco, Zorgeenheid Traumatologie, Experimentele Afdeling Longziekten, Other research (not in main researchprogram), CDL Arcadia, Infection & Immunity, Hesselink, Lillian, Hoepelman, Ruben J., Spijkerman, Roy, de Groot, Mark C.H., van Wessem, Karlijn J.P., Koenderman, Leo, Leenen, Luke P.H., and Hietbrink, Falco

Published
2020

25. Global changes in mortality rates in polytrauma patients admitted to the ICU - A systematic review

Author

Zorgeenheid Traumatologie, Other research (not in main researchprogram), Infection & Immunity, Van Breugel, Johanna M.M., Niemeyer, Menco J.S., Houwert, Roderick M., Groenwold, Rolf H.H., Leenen, Luke P.H., Van Wessem, Karlijn J.P., Zorgeenheid Traumatologie, Other research (not in main researchprogram), Infection & Immunity, Van Breugel, Johanna M.M., Niemeyer, Menco J.S., Houwert, Roderick M., Groenwold, Rolf H.H., Leenen, Luke P.H., and Van Wessem, Karlijn J.P.

Published
2020

26. The evolution of trauma care in the Netherlands over 20 years

Author

Zorgeenheid Traumatologie, DHS-Medisch, Hietbrink, Falco, Houwert, Roderick M., van Wessem, Karlijn J.P., Simmermacher, Rogier K.J., Govaert, Geertje A.M., de Jong, Mirjam B., de Bruin, Ivar G.J., de Graaf, Johan, Leenen, Loek P.H., Zorgeenheid Traumatologie, DHS-Medisch, Hietbrink, Falco, Houwert, Roderick M., van Wessem, Karlijn J.P., Simmermacher, Rogier K.J., Govaert, Geertje A.M., de Jong, Mirjam B., de Bruin, Ivar G.J., de Graaf, Johan, and Leenen, Loek P.H.

Published
2020

29. Thromboelastography does not provide additional information to guide resuscitation in the severely injured

Author

van Wessem, Karlijn J.P. and Leenen, Luke P.H.

Subjects
conventional coagulation assay, thromboelastography, Surgery, polytrauma, haemostatic resuscitation
Abstract

Background: Haemostasis assessment is essential to determine the early need for massive transfusion in the treatment of polytrauma. Strategies to guide correction of coagulopathy vary widely. In order to evaluate thromboelastography (TEG) for this goal, a prospective study was performed comparing TEG to conventional coagulation assays (CCAs) in severely injured patients. Methods: Consecutive polytrauma patients admitted to the intensive care unit of a level-1 trauma centre were prospectively included over a 30-month period. All patients had CCA on arrival in emergency department. Patients who needed massive transfusion and underwent urgent surgery had additionally a Kaolin-activated TEG. Results: One hundred and thirty-five patients were included, 76% male, median age 45 years, 96% blunt injuries and median injury severity score was 29. One hundred and fourteen patients had CCA only and 21 patients had both CCA and TEG. Patients who had both CCA and TEG were acidotic, hypothermic and coagulopathic on arrival in emergency department. All 21 patients had normal TEG results even though prothrombin time was prolonged. Conclusions: TEGs were normal in all polytrauma patients even though patients were severely injured. They had prolonged prothrombin time, acidosis and hypothermia both on arrival and when TEG was measured. Caution should be exercised in interpretation of TEG results in treating polytrauma patients. In our system, with aggressive early haemostatic resuscitation, TEG does not provide additional information in guiding resuscitation.

Published
2018

31. A Rise in Neutrophil Cell Size Precedes Organ Dysfunction After Trauma

Author

Zorgeenheid Traumatologie, CDL Staf Patiëntenzorg KC, Infection & Immunity, Other research (not in main researchprogram), CDL Arcadia, Circulatory Health, Centraal Diagnostisch Laboratorium, Experimentele Afdeling Longziekten, Hesselink, Lillian, Heeres, Marjolein, Paraschiakos, Fotis, Ten Berg, Maarten, Huisman, Albert, Hoefer, Imo E., de Groot, Mark C.H., van Solinge, Wouter W., Dijkgraaf, Marcel, Hellebrekers, Pien, Van Wessem, Karlijn J.P., Koenderman, Leo, Leenen, Luke P.H., Hietbrink, Falco, Zorgeenheid Traumatologie, CDL Staf Patiëntenzorg KC, Infection & Immunity, Other research (not in main researchprogram), CDL Arcadia, Circulatory Health, Centraal Diagnostisch Laboratorium, Experimentele Afdeling Longziekten, Hesselink, Lillian, Heeres, Marjolein, Paraschiakos, Fotis, Ten Berg, Maarten, Huisman, Albert, Hoefer, Imo E., de Groot, Mark C.H., van Solinge, Wouter W., Dijkgraaf, Marcel, Hellebrekers, Pien, Van Wessem, Karlijn J.P., Koenderman, Leo, Leenen, Luke P.H., and Hietbrink, Falco

Published
2019

32. Similar change in platelets and leucocytes 24 h after injury is associated with septic shock a week later

Author

Jol, Saskia, Hietbrink, Falco, Leenen, Luke P.H., Koenderman, Leo, and van Wessem, Karlijn J.P.

Subjects
trauma, Journal Article, septic shock, Surgery, platelet and leucocyte correlation
Abstract

Background: Septic shock is a severe complication in polytrauma patients. Early identification of patients at risk can guide future prevention strategies. Platelets (PLTs) and leucocytes presumably play an important role in the post-injury inflammatory response. The role of early changes in PLT and leucocyte counts was investigated in search for the aetiology of the development of septic complications. Methods: Polytrauma patients (aged 16–80 years) admitted to the intensive care unit with an expected stay of at least 3 days were included. PLT and leucocyte counts were measured on a daily basis for 14 days. Results: A total of 41 patients were included, of whom nine (22%) developed septic shock. There was no difference in (New) Injury Severity Score or Acute Physiology and Chronic Health Evaluation II scores between patients who developed septic shock and patients who did not. Three patients died, one of them in septic shock. Patients who developed septic shock during hospital stay had lower PLTs and a slower recovery to normal PLT counts than patients without septic shock. Patients who developed either a decrease in both PLTs and leucocytes or an increase in PLTs and leucocytes in the first 24 h after trauma were more likely to develop septic shock. This correlation was not found in patients who did not develop septic shock. Conclusion: A similar change in PLT and leucocyte counts in the first 24 h after trauma is associated with the development of septic shock after a week. This indicates an early interaction between PLTs and leucocytes, which needs further investigation to gain more insight in the aetiology of post-injury septic complications.

Published
2017

34. Similar change in platelets and leucocytes 24 h after injury is associated with septic shock a week later

Author

UMC Utrecht, Arts-assistenten Radiologie, Zorgeenheid Traumatologie, Infection & Immunity, Experimentele Afdeling Longziekten, Jol, Saskia, Hietbrink, Falco, Leenen, Luke P.H., Koenderman, Leo, van Wessem, Karlijn J.P., UMC Utrecht, Arts-assistenten Radiologie, Zorgeenheid Traumatologie, Infection & Immunity, Experimentele Afdeling Longziekten, Jol, Saskia, Hietbrink, Falco, Leenen, Luke P.H., Koenderman, Leo, and van Wessem, Karlijn J.P.

Published
2017

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